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General NPI Number Information
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NPI Number | 1083042311
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Entity Type | Organization
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Legal Business Name | BODYWISE ACUPUNCTURE & TOTAL WELLNESS
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Dates
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Enumeration Date | 10/23/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 885 CANARIOS CT STE. 110
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City | CHULA VISTA
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State | CA
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Zip | 91910-7877
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Country | US
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Telephone | 619-656-5102
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Fax | 619-656-5143
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Provider Business Mailing Address
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Address Line | 885 CANARIOS CT STE. 110
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City | CHULA VISTA
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State | CA
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Zip | 91910-7877
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Country | US
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Telephone | 619-656-5102
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Fax | 619-656-5143
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GEORGIA GOOD
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Credential | L.AC., DIPL. OM
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Telephone | 619-210-5153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | AC15584
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License Number State | CA
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