Healthcare Provider Details

I. General information

NPI: 1770813412
Provider Name (Legal Business Name): SAN DIEGO ACUPUNCTURE AND NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 4TH AVE STE 210
SAN DIEGO CA
92103-4237
US

IV. Provider business mailing address

3636 4TH AVE STE 210
SAN DIEGO CA
92103-4237
US

V. Phone/Fax

Practice location:
  • Phone: 619-501-5654
  • Fax: 619-785-3387
Mailing address:
  • Phone: 619-887-0610
  • Fax: 619-785-3387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8921
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberCA115
License Number StateCA

VIII. Authorized Official

Name: DARCY MARIE DIVANTERRA
Title or Position: PRACTITIONER
Credential:
Phone: 619-887-0610