Healthcare Provider Details

I. General information

NPI: 1205160892
Provider Name (Legal Business Name): LEUCADIA FAMILY ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 NORTH COAST HIGHWAY, SUITE 1A
ENCINITAS CA
92024
US

IV. Provider business mailing address

1114 NORTH COAST HIGHWAY, SUITE 1A
ENCINITAS CA
92024
US

V. Phone/Fax

Practice location:
  • Phone: 760-943-7667
  • Fax: 760-943-7667
Mailing address:
  • Phone: 760-943-7667
  • Fax: 760-943-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 12901
License Number StateCA

VIII. Authorized Official

Name: MRS. REBECCA-ANNE STEWART
Title or Position: OWNER/ LICENSED ACUPUNCTURIST
Credential: L.AC.
Phone: 760-943-7667