Provider Demographics
NPI:1093976730
Name:NAGEL, JEFF (MA, LAC, DIPL AC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:NAGEL
Suffix:
Gender:M
Credentials:MA, LAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 1ST AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3037
Mailing Address - Country:US
Mailing Address - Phone:619-542-1903
Mailing Address - Fax:
Practice Address - Street 1:3838 1ST AVE APT 5
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3037
Practice Address - Country:US
Practice Address - Phone:619-542-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3106171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist