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General NPI Number Information
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NPI Number | 1205160892
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Entity Type | Organization
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Legal Business Name | LEUCADIA FAMILY ACUPUNCTURE
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 1114 NORTH COAST HIGHWAY, SUITE 1A
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City | ENCINITAS
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State | CA
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Zip | 92024
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Country | US
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Telephone | 760-943-7667
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Fax | 760-943-7667
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Provider Business Mailing Address
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Address Line | 1114 NORTH COAST HIGHWAY, SUITE 1A
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City | ENCINITAS
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State | CA
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Zip | 92024
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Country | US
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Telephone | 760-943-7667
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Fax | 760-943-7667
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Authorized Official
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Title or Position | OWNER/ LICENSED ACUPUNCTURIST
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Name | MRS. REBECCA-ANNE STEWART
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Credential | L.AC.
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Telephone | 760-943-7667
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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 | AC 12901
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License Number State | CA
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