Healthcare Provider Details

I. General information

NPI: 1821246638
Provider Name (Legal Business Name): MICHAEL D. CORRADINO DAOC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 JUTLAND DR 202
SAN DIEGO CA
92117-3663
US

IV. Provider business mailing address

4241 JUTLAND DR 103
SAN DIEGO CA
92117-3663
US

V. Phone/Fax

Practice location:
  • Phone: 858-490-3460
  • Fax: 858-490-3462
Mailing address:
  • Phone: 858-490-3460
  • Fax: 858-490-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: