Provider Demographics
NPI:1326101502
Name:SERVICE INTERNATIONAL,INC.
Entity Type:Organization
Organization Name:SERVICE INTERNATIONAL,INC.
Other - Org Name:PAIN AND STRESS ACUPUNCTURE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CONRADO
Authorized Official - Middle Name:EBREO
Authorized Official - Last Name:CASTRO JR.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-738-7008
Mailing Address - Street 1:120 NEPTUNE PL
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2076
Mailing Address - Country:US
Mailing Address - Phone:760-739-1949
Mailing Address - Fax:
Practice Address - Street 1:750 E GRAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4460
Practice Address - Country:US
Practice Address - Phone:760-738-7008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6841204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0068410OtherMEDICAL PROVIDER NO.