Healthcare Provider Details

I. General information

NPI: 1508011891
Provider Name (Legal Business Name): WENDI M MIYASHIRO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2481 CONGRESS ST
SAN DIEGO CA
92110-2820
US

IV. Provider business mailing address

3010 NILE ST
SAN DIEGO CA
92104-4810
US

V. Phone/Fax

Practice location:
  • Phone: 858-740-1838
  • Fax: 858-408-3212
Mailing address:
  • Phone: 858-740-1838
  • Fax: 858-408-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: