Provider Demographics
NPI:1467865485
Name:HOZHO HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:HOZHO HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RONNIE
Authorized Official - Last Name:PONTECORVO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LAC
Authorized Official - Phone:619-244-3986
Mailing Address - Street 1:10951 SORRENTO VALLEY RD STE 1D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1613
Mailing Address - Country:US
Mailing Address - Phone:619-244-3986
Mailing Address - Fax:
Practice Address - Street 1:10951 SORRENTO VALLEY RD STE 1D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1613
Practice Address - Country:US
Practice Address - Phone:619-244-3986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15877171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty