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General NPI Number Information
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NPI Number | 1760723290
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Entity Type | Individual
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Provider Name | RON CLYDE LORD JR. CA.LAC 9362
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Gender | Male
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 12396 WORLD TRADE DR STE 117
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City | SAN DIEGO
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State | CA
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Zip | 92128-3788
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Country | US
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Telephone | 858-458-0625
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Fax | 858-750-2174
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Provider Business Mailing Address
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Address Line | 12396 WORLD TRADE DR STE 117
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City | SAN DIEGO
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State | CA
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Zip | 92128-3788
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Country | US
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Telephone | 858-458-0625
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Fax | 858-750-2174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 9362
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License Number State | CA
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