Healthcare Provider Details

I. General information

NPI: 1083026223
Provider Name (Legal Business Name): YVONNE K SCARLETT L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5694 MISSION CENTER ROAD SUITE 602-178
SAN DIEGO CA
92108
US

IV. Provider business mailing address

5694 MISSION CENTER ROAD SUITE 602-178
SAN DIEGO CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 352-408-5403
  • Fax:
Mailing address:
  • Phone: 352-408-5403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16118
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number16118
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number16118
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: