Healthcare Provider Details

I. General information

NPI: 1104537679
Provider Name (Legal Business Name): DR. SAKYA INTEGRATIVE WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 N PARK WAY
SAN DIEGO CA
92104-3625
US

IV. Provider business mailing address

3080 N PARK WAY
SAN DIEGO CA
92104-3625
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-6616
  • Fax: 619-294-6618
Mailing address:
  • Phone: 619-294-6616
  • Fax: 619-294-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NAMRATA SAKYA
Title or Position: LICENSED ACUPUNCTURIST
Credential: DACM
Phone: 619-294-6616