Healthcare Provider Details

I. General information

NPI: 1225560402
Provider Name (Legal Business Name): ACU-FIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 SWEET PEA PL
ENCINITAS CA
92024-7713
US

IV. Provider business mailing address

582 SWEET PEA PL
ENCINITAS CA
92024-7713
US

V. Phone/Fax

Practice location:
  • Phone: 760-587-3662
  • Fax: 858-509-3993
Mailing address:
  • Phone: 760-587-3662
  • Fax: 858-509-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13480
License Number StateCA

VIII. Authorized Official

Name: PHILIP GALLO
Title or Position: ACUPUNCTURIST
Credential: L.AC
Phone: 760-587-3662