Healthcare Provider Details

I. General information

NPI: 1780606095
Provider Name (Legal Business Name): M DAVID TEIXEIRA LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 3RD AVE SUITE B
SAN DIEGO CA
92103-5683
US

IV. Provider business mailing address

2707 CAMULOS ST APT # 7
SAN DIEGO CA
92107-1160
US

V. Phone/Fax

Practice location:
  • Phone: 619-200-1522
  • Fax:
Mailing address:
  • Phone: 619-200-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number8821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: