Provider Demographics
NPI:1326194143
Name:HOGAN, MICHAEL GORRILL (CA LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GORRILL
Last Name:HOGAN
Suffix:
Gender:M
Credentials:CA LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2005
Mailing Address - Country:US
Mailing Address - Phone:760-634-1969
Mailing Address - Fax:
Practice Address - Street 1:2210 ENCINITAS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-632-7728
Practice Address - Fax:760-632-7730
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6699171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist