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General NPI Number Information
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NPI Number | 1134701477
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Entity Type | Individual
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Provider Name | ELAINE STA-IGLESIA LAC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 1009 TERRA NOVA BLVD
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City | PACIFICA
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State | CA
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Zip | 94044-4308
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Country | US
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Telephone | 650-440-6647
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Fax |
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Provider Business Mailing Address
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Address Line | 208 AVALON DR
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City | DALY CITY
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State | CA
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Zip | 94015-4601
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Country | US
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Telephone | 415-203-0590
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Fax |
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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 | 19075
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License Number State | CA
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