Healthcare Provider Details

I. General information

NPI: 1578075362
Provider Name (Legal Business Name): CHRISTIE TERUEL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE C117
LA JOLLA CA
92037-1707
US

IV. Provider business mailing address

831 CEDARBEND WAY
CHULA VISTA CA
91910-6639
US

V. Phone/Fax

Practice location:
  • Phone: 858-202-0322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: