Healthcare Provider Details

I. General information

NPI: 1730504051
Provider Name (Legal Business Name): RANDALL WEGENER ACUPUNCTURIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 E ELDER ST STE A
FALLBROOK CA
92028-5000
US

IV. Provider business mailing address

593 E ELDER ST STE A
FALLBROOK CA
92028-5000
US

V. Phone/Fax

Practice location:
  • Phone: 760-451-2188
  • Fax:
Mailing address:
  • Phone: 760-451-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: RANDALL WAYNE WEGENER
Title or Position: OWNER
Credential: L. AC., DIPL. AC.
Phone: 760-451-2188