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General NPI Number Information
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NPI Number | 1306403316
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Entity Type | Individual
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Provider Name | DOMENICK BARBO LAC
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Gender | Male
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 269 CYPRESS ST
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City | PISMO BEACH
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State | CA
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Zip | 93449-2602
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Country | US
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Telephone | 808-295-7752
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Fax |
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Provider Business Mailing Address
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Address Line | 850 S ROSEMEAD BLVD APT 17
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City | PASADENA
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State | CA
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Zip | 91107-5677
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 73794
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 19336
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License Number State | CA
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