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General NPI Number Information
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NPI Number | 1154685774
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Entity Type | Individual
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Provider Name | GREGORY DINO GUILLERMO LAC
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Gender | Male
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 15644 POMERADO RD STE 400
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City | POWAY
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State | CA
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Zip | 92064-2418
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Country | US
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Telephone | 858-312-1672
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Fax | 858-312-6421
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Provider Business Mailing Address
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Address Line | 1547 E WASHINGTON AVE APT 3
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City | EL CAJON
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State | CA
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Zip | 92019-2558
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Country | US
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Telephone | 619-507-6783
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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 | AC13039
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License Number State | CA
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