Healthcare Provider Details

I. General information

NPI: 1396504072
Provider Name (Legal Business Name): ACUPUNCTURE FOR MIND & BODY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12243 POWAY RD
POWAY CA
92064-4217
US

IV. Provider business mailing address

12243 POWAY RD
POWAY CA
92064-4217
US

V. Phone/Fax

Practice location:
  • Phone: 858-261-8038
  • Fax: 858-380-4248
Mailing address:
  • Phone: 858-261-8038
  • Fax: 858-380-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: PIN LU
Title or Position: ACUPUNCTURIST
Credential:
Phone: 858-261-8038