Healthcare Provider Details

I. General information

NPI: 1972187284
Provider Name (Legal Business Name): LA JOLLA ONCOLOGY ACUPUNCTURE & MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 IVANHOE AVE STE 212
LA JOLLA CA
92037-4508
US

IV. Provider business mailing address

7855 IVANHOE AVE STE 212
LA JOLLA CA
92037-4508
US

V. Phone/Fax

Practice location:
  • Phone: 858-224-3690
  • Fax:
Mailing address:
  • Phone: 858-224-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. LUCY FRANCES JEANSONNE PAUSEBACK
Title or Position: DR/OWNER
Credential: DACM, LAC
Phone: 858-224-3690