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General NPI Number Information
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NPI Number | 1417200072
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Entity Type | Individual
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Provider Name | PANCHAPON IVY STUBBLEFIELD L.AC
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Gender | Female
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 333 S JUNIPER ST SUITE 111
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City | ESCONDIDO
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State | CA
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Zip | 92025-4924
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Country | US
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Telephone | 760-215-0551
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Fax | 760-317-1827
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Provider Business Mailing Address
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Address Line | PO BOX 1570
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City | ESCONDIDO
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State | CA
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Zip | 92033-1570
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Country | US
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Telephone | 760-215-0551
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Fax | 760-317-1827
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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 | 15049
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License Number State | CA
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