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General NPI Number Information
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NPI Number | 1447636741
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Entity Type | Individual
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Provider Name | MICHELLE MOON B.S., MAOM, L.AC.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 2425 CAMINO DEL RIO S STE 150
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City | SAN DIEGO
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State | CA
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Zip | 92108-3770
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Country | US
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Telephone | 858-212-6711
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Fax |
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Provider Business Mailing Address
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Address Line | 13374 GREENSTONE CT
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City | SAN DIEGO
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State | CA
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Zip | 92131-4242
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 16429
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License Number State | CA
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