Provider Demographics
NPI:1013379783
Name:PB ACU
Entity Type:Organization
Organization Name:PB ACU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, L.AC.
Authorized Official - Prefix:
Authorized Official - First Name:ANDREIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABOYA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:619-664-9907
Mailing Address - Street 1:2180 GARNET AVE STE 2G
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3675
Mailing Address - Country:US
Mailing Address - Phone:619-664-9907
Mailing Address - Fax:
Practice Address - Street 1:2180 GARNET AVE STE 2G
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3675
Practice Address - Country:US
Practice Address - Phone:619-664-9907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12867171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty