Healthcare Provider Details

I. General information

NPI: 1982658993
Provider Name (Legal Business Name): JANE GRANSEE MERGENS L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9019 PARK PLAZA DR STE D
LA MESA CA
91942-3443
US

IV. Provider business mailing address

9451 PINO DR
LAKESIDE CA
92040-4336
US

V. Phone/Fax

Practice location:
  • Phone: 619-606-6464
  • Fax: 619-579-8573
Mailing address:
  • Phone: 619-606-6464
  • Fax: 619-579-8573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: