Healthcare Provider Details

I. General information

NPI: 1508914128
Provider Name (Legal Business Name): GROSSMONT MEDICAL CENTER ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 500 BLDG 3
LA MESA CA
91942-3024
US

IV. Provider business mailing address

5565 GROSSMONT CENTER DR STE 500 BLDG 3
LA MESA CA
91942-3024
US

V. Phone/Fax

Practice location:
  • Phone: 619-465-8800
  • Fax: 619-465-8808
Mailing address:
  • Phone: 619-465-8800
  • Fax: 619-465-8808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10036
License Number StateCA

VIII. Authorized Official

Name: MR. GHASSAN ELKHOURY
Title or Position: PARTNER
Credential: L.AC.
Phone: 619-465-8800