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General NPI Number Information
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NPI Number | 1942026976
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Entity Type | Individual
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Provider Name | MARY VINCENT LAC
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Gender | Female
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 1149 N 2ND ST
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City | EL CAJON
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State | CA
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Zip | 92021-5024
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Country | US
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Telephone | 619-440-2440
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Fax | 619-440-9440
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Provider Business Mailing Address
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Address Line | 2712 MASSACHUSETTS AVE
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City | LEMON GROVE
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State | CA
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Zip | 91945-2738
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Country | US
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Telephone | 619-306-3735
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Fax |
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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 | 13096
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License Number State | CA
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