Healthcare Provider Details

I. General information

NPI: 1659495992
Provider Name (Legal Business Name): NISEEMA AGARWAL L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 3RD ST
ENCINITAS CA
92024-4415
US

IV. Provider business mailing address

826 3RD ST
ENCINITAS CA
92024-4415
US

V. Phone/Fax

Practice location:
  • Phone: 760-635-1542
  • Fax:
Mailing address:
  • Phone: 760-635-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: