Healthcare Provider Details

I. General information

NPI: 1871960070
Provider Name (Legal Business Name): ALLERGY AND ACUPUNCTURE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR SUITE C117
LA JOLLA CA
92037-1714
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR SUITE C117
LA JOLLA CA
92037-1714
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 TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13469
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4456
License Number StateCA

VIII. Authorized Official

Name: DR. ROYA NIKZAD
Title or Position: OWNER
Credential: PHD, LAC
Phone: 858-202-0322