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NPI Code Detail

MEDICARE: CLASSICAL ACUPUNCTURE ASSOCIATES HEALING ARTS CENTER OF SAN DIEGO, INC

MEDICARE: CLASSICAL ACUPUNCTURE ASSOCIATES HEALING ARTS CENTER OF SAN DIEGO, 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
1171100000XAcupuncturistCA8951CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11255368775OTHERNPI
2AC8951OTHERCAACUPUNCTURE LICENSE #

General Provider Information

NPI Number : 1720595929
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLASSICAL ACUPUNCTURE ASSOCIATES HEALING ARTS CENTER OF SAN DIEGO, INC
Provider Business Mailing Address
First Line : 2515 CAMINO DEL RIO S STE 110
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3714
Country : US
Telephone Number : 619-688-0061
Fax Number : 619-688-0026
Provider Business Practice Location Address
First Line : 2515 CAMINO DEL RIO S STE 110
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3714
Country : US
Telephone Number : 619-688-0061
Fax Number : 619-688-0026
Authorized Official
Title or Position : MS
Name : MS. JENNIFER MOFFITT
Credential : L.AC. DP.OM
Telephone Number : 619-688-0061
Provider Enumeration Date : 01/09/2018
Last Update Date : 01/09/2018

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Directions to “CLASSICAL ACUPUNCTURE ASSOCIATES HEALING ARTS CENTER OF SAN DIEGO, INC ” Practice Location

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