Healthcare Provider Details

I. General information

NPI: 1659466167
Provider Name (Legal Business Name): JOANNE MARY LACROIX L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MORAGA AVE. SUITE A305
SAN DIEGO CA
92117
US

IV. Provider business mailing address

6057 CAMINITO DEL OESTE
SAN DIEGO CA
92111
US

V. Phone/Fax

Practice location:
  • Phone: 858-454-9771
  • Fax: 858-454-9785
Mailing address:
  • Phone: 858-278-8786
  • Fax: 858-278-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: