Healthcare Provider Details

I. General information

NPI: 1518354166
Provider Name (Legal Business Name): SYLVVARI RYU'XTIEL L. AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 08/22/2020
Certification Date: 08/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10914 PORTOBELO DR
SAN DIEGO CA
92124-1181
US

IV. Provider business mailing address

10914 PORTOBELO DR
SAN DIEGO CA
92124-1181
US

V. Phone/Fax

Practice location:
  • Phone: 858-309-2037
  • Fax:
Mailing address:
  • Phone: 858-309-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: