MEDICARE: MRS. ELISA MARIE KRETH L.AC

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	10637	CA

General Provider Information

NPI Number	:	1235157884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELISA MARIE KRETH L.AC

Provider Business Mailing Address
First Line	:	12264 EL CAMINO REAL
Second Line	:	SUITE 108
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3060
Country	:	US
Telephone Number	:	858-481-0303
Fax Number	:	858-481-9797

Provider Business Practice Location Address
First Line	:	12264 EL CAMINO REAL
Second Line	:	SUITE 108
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3060
Country	:	US
Telephone Number	:	858-481-0303
Fax Number	:	858-481-9797

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	02/27/2017

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