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General NPI Number Information
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NPI Number | 1043986557
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Entity Type | Individual
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Provider Name | KRISTO KUCARIC JR. L. AC.
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Gender | Male
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1335 BROAD ST STE A
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-1932
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Country | US
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Telephone | 805-395-6881
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Fax | 805-855-4178
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Provider Business Mailing Address
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Address Line | 1241 JOHNSON AVE # 137
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3306
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Country | US
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Telephone | 619-822-0843
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Fax | 805-855-4178
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 16130
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License Number State | CA
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