Healthcare Provider Details

I. General information

NPI: 1982108189
Provider Name (Legal Business Name): ANDREA IRENE PLICHTA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 LA JOLLA BLVD STE 201
LA JOLLA CA
92037-6156
US

IV. Provider business mailing address

6830 LA JOLLA BLVD STE 201
LA JOLLA CA
92037-6156
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-0899
  • Fax:
Mailing address:
  • Phone: 858-459-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: