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General NPI Number Information
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NPI Number | 1659788099
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Entity Type | Organization
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Legal Business Name | HERBIN INC
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 2801 4TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-6207
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Country | US
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Telephone | 619-564-8308
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 4TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-6207
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Country | US
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Telephone | 619-564-8308
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARA KOLJONEN
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Credential | L.AC
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Telephone | 619-564-8308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number |
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License Number State |
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Taxonomy #2
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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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