Provider Demographics
NPI:1356852404
Name:ROGITZ, CHELSEY (LAC)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:
Last Name:ROGITZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:
Other - Last Name:SONGY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2361 GRACE LN
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-2827
Mailing Address - Country:US
Mailing Address - Phone:760-799-2687
Mailing Address - Fax:
Practice Address - Street 1:2515 CAMINO DEL RIO S STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3714
Practice Address - Country:US
Practice Address - Phone:619-688-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist