MEDICARE: LINDSAY WUNSCH LAC

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	225700000X	Massage Therapist	74268	CA
2	171100000X	Acupuncturist	AC18621	CA

General Provider Information

NPI Number	:	1174096283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY WUNSCH LAC

Provider Business Mailing Address
First Line	:	4501 MISSION BAY DR STE 2D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4925
Country	:	US
Telephone Number	:	631-897-4772
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 MISSION BAY DR STE 2D
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4925
Country	:	US
Telephone Number	:	631-897-4772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	12/20/2022

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Directions to “ LINDSAY WUNSCH LAC” Practice Location

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