Healthcare Provider Details

I. General information

NPI: 1043986557
Provider Name (Legal Business Name): KRISTO KUCARIC JR. L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 BROAD ST STE A
SAN LUIS OBISPO CA
93401-1932
US

IV. Provider business mailing address

1241 JOHNSON AVE # 137
SAN LUIS OBISPO CA
93401-3306
US

V. Phone/Fax

Practice location:
  • Phone: 805-395-6881
  • Fax: 805-855-4178
Mailing address:
  • Phone: 619-822-0843
  • Fax: 805-855-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: