Healthcare Provider Details

I. General information

NPI: 1235960329
Provider Name (Legal Business Name): SAGE TRADITIONS ACUPUNCTURE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PALM AVE STE 2
IMPERIAL BEACH CA
91932-1018
US

IV. Provider business mailing address

792 7TH ST
IMPERIAL BEACH CA
91932-2106
US

V. Phone/Fax

Practice location:
  • Phone: 619-392-0937
  • Fax: 619-565-2288
Mailing address:
  • Phone: 619-392-0937
  • Fax: 619-565-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BRUCE STEWART
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: L.AC.
Phone: 619-392-0937