Healthcare Provider Details

I. General information

NPI: 1508514837
Provider Name (Legal Business Name): JULIA CANDELARIA DACM, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7522 LA JOLLA BLVD
LA JOLLA CA
92037-4720
US

IV. Provider business mailing address

1013 AGATE ST APT A
SAN DIEGO CA
92109-1279
US

V. Phone/Fax

Practice location:
  • Phone: 858-900-3525
  • Fax:
Mailing address:
  • Phone: 760-291-7349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: