Healthcare Provider Details

I. General information

NPI: 1316012701
Provider Name (Legal Business Name): AMY ELIZABETH ROGERS-CAVENDER M.S., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 ENCINITAS BLVD SUITE 316
ENCINITAS CA
92024-3762
US

IV. Provider business mailing address

431 OCEANVIEW DR
VISTA CA
92084-6117
US

V. Phone/Fax

Practice location:
  • Phone: 760-415-8776
  • Fax:
Mailing address:
  • Phone: 760-415-8776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: