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General NPI Number Information
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NPI Number | 1639633316
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Entity Type | Organization
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Legal Business Name | CASA ZEN ACUPUNCTURE INC
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Dates
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Enumeration Date | 01/26/2019
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Last Update Date | 01/26/2019
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Provider Practice Location Address
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Address Line | 4190 BONITA RD STE 209
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City | BONITA
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State | CA
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Zip | 91902-1340
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Country | US
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Telephone | 619-925-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 1129 PACIFIC GROVE LOOP
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City | CHULA VISTA
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State | CA
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Zip | 91915-2114
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Country | US
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Telephone | 619-587-2331
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | JEANETTE M CARRANZA ISLAS
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Credential | LAC, MSTOM
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Telephone | 619-925-2017
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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 |
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License Number State |
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