Healthcare Provider Details

I. General information

NPI: 1003675299
Provider Name (Legal Business Name): TIDAL ACUPUNCTURE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 EL CAJON BLVD STE A
SAN DIEGO CA
92103-2591
US

IV. Provider business mailing address

3521 LOUISIANA ST
SAN DIEGO CA
92104-4022
US

V. Phone/Fax

Practice location:
  • Phone: 619-633-7275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. RACHEL EUSEBIO
Title or Position: CO-OWNER
Credential: DACM
Phone: 775-720-6315