Healthcare Provider Details

I. General information

NPI: 1588087274
Provider Name (Legal Business Name): OLIVER GERTZKI L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 ENCINITAS BLVD STE 316
ENCINITAS CA
92024-3762
US

IV. Provider business mailing address

681 ENCINITAS BLVD STE 316
ENCINITAS CA
92024-3762
US

V. Phone/Fax

Practice location:
  • Phone: 760-282-4594
  • Fax: 760-632-6980
Mailing address:
  • Phone: 760-282-4594
  • Fax: 760-632-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 15545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: