Healthcare Provider Details

I. General information

NPI: 1124533534
Provider Name (Legal Business Name): ANNA KRASHENNNIKOVA, L. AC. , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N EL CAMINO REAL STE 104
ENCINITAS CA
92024-2812
US

IV. Provider business mailing address

PO BOX 230341
ENCINITAS CA
92023-0341
US

V. Phone/Fax

Practice location:
  • Phone: 760-710-0234
  • Fax: 760-479-0233
Mailing address:
  • Phone: 760-710-0234
  • Fax: 760-479-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14316
License Number StateCA

VIII. Authorized Official

Name: DR. ANNA KRASHENINNIKOVA
Title or Position: PRESIDENT
Credential: DAOM, L.AC.
Phone: 760-710-0234