Healthcare Provider Details

I. General information

NPI: 1053891432
Provider Name (Legal Business Name): THE INN SPOT COMMUNITY ACUPUNCTURE & STRESS RELIEF LOUNGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 CAMINO DEL RIO S STE 338
SAN DIEGO CA
92108-4017
US

IV. Provider business mailing address

1621 HOTEL CIR S # 128
SAN DIEGO CA
92108-3323
US

V. Phone/Fax

Practice location:
  • Phone: 619-550-5200
  • Fax: 619-550-5300
Mailing address:
  • Phone: 619-322-2713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: GUY PAGE
Title or Position: OWNER
Credential:
Phone: 619-322-2713