Provider Demographics
NPI:1407095029
Name:KRAHN, SHELLY ANNETTE (LAC)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:ANNETTE
Last Name:KRAHN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:ANNETTE
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:6540 REFLECTION DR
Mailing Address - Street 2:#1224
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-5119
Mailing Address - Country:US
Mailing Address - Phone:760-419-6863
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 860
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:760-419-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3512171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist