Healthcare Provider Details

I. General information

NPI: 1972678951
Provider Name (Legal Business Name): ROYA NIKZAD PH.D, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR. SUITE C-117
LA JOLLA CA
92037-1707
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR. SUITE C-117
LA JOLLA CA
92037-1707
US

V. Phone/Fax

Practice location:
  • Phone: 858-202-0322
  • Fax: 858-546-1575
Mailing address:
  • Phone: 858-202-0322
  • Fax: 858-546-1575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: