Healthcare Provider Details

I. General information

NPI: 1659962876
Provider Name (Legal Business Name): MASHIL CHEUNG HERCEG DACM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MASHIL CHEUNG DACM, L.AC.

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 01/30/2021
Certification Date: 01/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 SHERIDAN RD
ENCINITAS CA
92024-1140
US

IV. Provider business mailing address

1822 SHERIDAN RD
ENCINITAS CA
92024-1140
US

V. Phone/Fax

Practice location:
  • Phone: 760-642-9951
  • Fax:
Mailing address:
  • Phone: 760-642-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC19001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: