Healthcare Provider Details

I. General information

NPI: 1255493979
Provider Name (Legal Business Name): CARMENCITA GARCIA CASTRO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E GRAND AVE SUITE A
ESCONDIDO CA
92025-4460
US

IV. Provider business mailing address

120 NEPTUNE PL
ESCONDIDO CA
92026-2076
US

V. Phone/Fax

Practice location:
  • Phone: 760-738-7008
  • Fax: 760-738-1459
Mailing address:
  • Phone: 760-420-7596
  • Fax: 760-739-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 6841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: