Healthcare Provider Details

I. General information

NPI: 1932131539
Provider Name (Legal Business Name): PACIFIC CENTER OF HEALTH AND ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 CAMINO DEL RIO S. #201
SAN DIEGO CA
92108
US

IV. Provider business mailing address

2615 CAMINO DEL RIO S. #201
SAN DIEGO CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 619-542-0884
  • Fax: 619-542-0949
Mailing address:
  • Phone: 619-542-0884
  • Fax: 619-542-0949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2209
License Number StateCA

VIII. Authorized Official

Name: TIFFANY ANDERSEN
Title or Position: BUSINESS MANAGER
Credential: BS
Phone: 619-542-0884