Healthcare Provider Details

I. General information

NPI: 1295390433
Provider Name (Legal Business Name): EVELYN OHASHI DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AVA OHASHI DACM

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 HOTEL CIR S STE 120
SAN DIEGO CA
92108-3414
US

IV. Provider business mailing address

1545 HOTEL CIR S STE 120
SAN DIEGO CA
92108-3414
US

V. Phone/Fax

Practice location:
  • Phone: 619-639-8559
  • Fax: 619-413-6303
Mailing address:
  • Phone: 619-639-8559
  • Fax: 619-413-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: