=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588087274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLIVER GERTZKI L.AC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2014
-----------------------------------------------------
Last Update Date | 01/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 681 ENCINITAS BLVD STE 316
-----------------------------------------------------
City | ENCINITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92024-3762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-282-4594
-----------------------------------------------------
Fax | 760-632-6980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 681 ENCINITAS BLVD STE 316
-----------------------------------------------------
City | ENCINITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92024-3762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-282-4594
-----------------------------------------------------
Fax | 760-632-6980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 15545
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------