Provider Demographics
NPI:1467719898
Name:BARNUM, SANDRA JANE (LAC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:BARNUM
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 1:2658 DEL MAR HEIGHTS RD
Mailing Address - Street 2:#292
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3100
Mailing Address - Country:US
Mailing Address - Phone:619-259-7410
Mailing Address - Fax:
Practice Address - Street 1:6540 LUSK BLVD
Practice Address - Street 2:SUITE C139
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2767
Practice Address - Country:US
Practice Address - Phone:619-259-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14785171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist