Provider Demographics
NPI:1073666186
Name:DIVANTERRA, DARCY MARIE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:DARCY
Middle Name:MARIE
Last Name:DIVANTERRA
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 4TH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6529
Mailing Address - Country:US
Mailing Address - Phone:619-887-0610
Mailing Address - Fax:619-785-3387
Practice Address - Street 1:3636 4TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4237
Practice Address - Country:US
Practice Address - Phone:619-887-0610
Practice Address - Fax:619-785-3387
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8921171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist