Healthcare Provider Details

I. General information

NPI: 1699036780
Provider Name (Legal Business Name): LANAHAN ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 LA VETA AVE
ENCINITAS CA
92024-2014
US

IV. Provider business mailing address

451 LA VETA AVE
ENCINITAS CA
92024-2014
US

V. Phone/Fax

Practice location:
  • Phone: 760-652-1116
  • Fax:
Mailing address:
  • Phone: 760-652-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11360
License Number StateCA

VIII. Authorized Official

Name: ASHLEY TALBOT LANAHAN
Title or Position: OWNER/ACUPUNCTURIST
Credential: L.AC.
Phone: 760-652-1116