Healthcare Provider Details

I. General information

NPI: 1659788099
Provider Name (Legal Business Name): HERBIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 4TH AVE
SAN DIEGO CA
92103-6207
US

IV. Provider business mailing address

2801 4TH AVE
SAN DIEGO CA
92103-6207
US

V. Phone/Fax

Practice location:
  • Phone: 619-564-8308
  • Fax:
Mailing address:
  • Phone: 619-564-8308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State

VIII. Authorized Official

Name: LARA KOLJONEN
Title or Position: PRESIDENT
Credential: L.AC
Phone: 619-564-8308