Healthcare Provider Details

I. General information

NPI: 1962881599
Provider Name (Legal Business Name): LISA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 GARDEN VIEW CT. STE: 201
ENCINITAS CA
92024
US

IV. Provider business mailing address

781 GARDEN VIEW CT. STE: 201
ENCINITAS CA
92024
US

V. Phone/Fax

Practice location:
  • Phone: 760-479-0122
  • Fax: 760-874-2999
Mailing address:
  • Phone: 760-479-0122
  • Fax: 760-874-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: