Healthcare Provider Details

I. General information

NPI: 1467865485
Provider Name (Legal Business Name): HOZHO HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10951 SORRENTO VALLEY RD STE 1D
SAN DIEGO CA
92121-1613
US

IV. Provider business mailing address

10951 SORRENTO VALLEY RD STE 1D
SAN DIEGO CA
92121-1613
US

V. Phone/Fax

Practice location:
  • Phone: 619-244-3986
  • Fax:
Mailing address:
  • Phone: 619-244-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15877
License Number StateCA

VIII. Authorized Official

Name: MR. ROBERT RONNIE PONTECORVO JR.
Title or Position: OWNER ACUPUNCTURIST
Credential: LAC
Phone: 619-244-3986