Healthcare Provider Details

I. General information

NPI: 1275200065
Provider Name (Legal Business Name): MICHELLE DUNN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE DUNN LAC

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 RUFFIN RD STE 315
SAN DIEGO CA
92123-1868
US

IV. Provider business mailing address

3796 DOVE ST
SAN DIEGO CA
92103-3979
US

V. Phone/Fax

Practice location:
  • Phone: 619-917-2958
  • Fax:
Mailing address:
  • Phone: 305-494-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: