Healthcare Provider Details

I. General information

NPI: 1477585867
Provider Name (Legal Business Name): RUISHAN GAO L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

12925 POMERADO RD STE F
POWAY CA
92064-5356
US

IV. Provider business mailing address

12925 POMERADO RD STE F
POWAY CA
92064-5356
US

V. Phone/Fax

Practice location:
  • Phone: 858-391-2746
  • Fax: 858-391-2746
Mailing address:
  • Phone: 858-391-2746
  • Fax: 858-391-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: