MEDICARE: DAVINA E LYNCH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1144775321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVINA E LYNCH INC

Provider Business Mailing Address
First Line	:	PO BOX 90724
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92169-2724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 PARK BLVD STE A3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2689
Country	:	US
Telephone Number	:	619-204-6956
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVINA LYNCH
Credential	:
Telephone Number	:	619-204-6956

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	08/18/2016

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