Provider Demographics
NPI:1316197023
Name:WYNNE, JULIA ELIZABETH (LAC)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:ELIZABETH
Last Name:WYNNE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 1ST AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6575
Mailing Address - Country:US
Mailing Address - Phone:619-251-1925
Mailing Address - Fax:
Practice Address - Street 1:2560 1ST AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6575
Practice Address - Country:US
Practice Address - Phone:619-251-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6126171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist