Provider Demographics
NPI:1134498272
Name:CINNABAR ACUPUNCTURE CLINIC & SPA
Entity Type:Organization
Organization Name:CINNABAR ACUPUNCTURE CLINIC & SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:GOULART
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DAOM
Authorized Official - Phone:858-312-5600
Mailing Address - Street 1:10432 RESERVE DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3509
Mailing Address - Country:US
Mailing Address - Phone:858-312-5600
Mailing Address - Fax:858-312-5636
Practice Address - Street 1:10432 RESERVE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3509
Practice Address - Country:US
Practice Address - Phone:858-312-5600
Practice Address - Fax:858-312-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10550171100000X
CA10551171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty