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General NPI Number Information
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NPI Number | 1720595929
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Entity Type | Organization
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Legal Business Name | CLASSICAL ACUPUNCTURE ASSOCIATES HEALING ARTS CENTER OF SAN DIEGO, INC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 2515 CAMINO DEL RIO S STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92108-3714
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Country | US
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Telephone | 619-688-0061
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Fax | 619-688-0026
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Provider Business Mailing Address
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Address Line | 2515 CAMINO DEL RIO S STE 110
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City | SAN DIEGO
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State | CA
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Zip | 92108-3714
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Country | US
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Telephone | 619-688-0061
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Fax | 619-688-0026
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Authorized Official
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Title or Position | MS
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Name | MS. JENNIFER MOFFITT
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Credential | L.AC. DP.OM
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Telephone | 619-688-0061
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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 | CA8951
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License Number State | CA
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