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General NPI Number Information
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NPI Number | 1538427976
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Entity Type | Organization
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Legal Business Name | EASTLAKE ACUPUNCTURE INC.
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 4550 KEARNY VILLA RD STE 208
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 619-609-5300
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Fax | 619-550-3269
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Provider Business Mailing Address
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Address Line | 4550 KEARNY VILLA RD STE 208
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 619-609-5300
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Fax | 619-550-3269
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST OWNER OF EAS
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Name | DR. NADIA AYADI
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Credential | DTCM, L.AC.
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Telephone | 619-609-5300
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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 | 14621
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License Number State | CA
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