Healthcare Provider Details

I. General information

NPI: 1780848192
Provider Name (Legal Business Name): GEORGE RITACHKA JR. L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GARDEN VIEW RD STE 106
ENCINITAS CA
92024-2475
US

IV. Provider business mailing address

2658 DEL MAR HEIGHTS RD # 136
DEL MAR CA
92014-3100
US

V. Phone/Fax

Practice location:
  • Phone: 858-342-9770
  • Fax:
Mailing address:
  • Phone: 858-342-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 9046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: