Healthcare Provider Details

I. General information

NPI: 1871527044
Provider Name (Legal Business Name): ERIKA NOVAK L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 MISSION BAY DR STE 3E
SAN DIEGO CA
92109-4926
US

IV. Provider business mailing address

4501 MISSION BAY DR STE 3E
SAN DIEGO CA
92109-4926
US

V. Phone/Fax

Practice location:
  • Phone: 858-450-0196
  • Fax: 858-272-1731
Mailing address:
  • Phone: 858-450-0196
  • Fax: 858-272-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 4544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: