Healthcare Provider Details

I. General information

NPI: 1760635726
Provider Name (Legal Business Name): CHRISTINA ANDRADE LEIGH MAOM, LAC, DIPL.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA A. BALANGUE MAOM, LAC, DIPL.AC.

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 2ND ST
ENCINITAS CA
92024-5009
US

IV. Provider business mailing address

539 WILLOWSPRING DR S
ENCINITAS CA
92024-4104
US

V. Phone/Fax

Practice location:
  • Phone: 760-383-1460
  • Fax:
Mailing address:
  • Phone: 858-245-1817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: