Healthcare Provider Details

I. General information

NPI: 1962633834
Provider Name (Legal Business Name): REBECCA ANNE STEWART L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 NORTH COAST HIGHWAY SUITE 1A
ENCINITAS CA
92024
US

IV. Provider business mailing address

1106 HYMETTUS AVE
ENCINITAS CA
92024-1742
US

V. Phone/Fax

Practice location:
  • Phone: 760-943-7667
  • Fax: 760-943-7667
Mailing address:
  • Phone: 760-943-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 12901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: