Healthcare Provider Details

I. General information

NPI: 1316698616
Provider Name (Legal Business Name): HEATHER PANNETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7924 IVANHOE AVE STE 6
LA JOLLA CA
92037-4552
US

IV. Provider business mailing address

5080 CAMINO DEL ARROYO APT 453
SAN DIEGO CA
92108-3178
US

V. Phone/Fax

Practice location:
  • Phone: 858-396-9711
  • Fax:
Mailing address:
  • Phone: 330-554-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20492
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number88190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: