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General NPI Number Information
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NPI Number | 1205257995
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Entity Type | Individual
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Provider Name | LYNN MARIA MINERVINI L.AC. MSTOM
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Gender | Female
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Dates
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Enumeration Date | 12/23/2013
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 12702 VIA CORTINA SUITE 100D
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City | DEL MAR
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State | CA
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Zip | 92014-3769
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Country | US
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Telephone | 914-391-2346
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2882
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City | DEL MAR
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State | CA
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Zip | 92014-5882
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Country | US
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Telephone | 914-391-2346
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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 | 15663
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License Number State | CA
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