Provider Demographics
NPI:1477907137
Name:SHANTI ACUPUNCTURE
Entity Type:Organization
Organization Name:SHANTI ACUPUNCTURE
Other - Org Name:MIRAMAR ACUPUNCTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTI
Authorized Official - Middle Name:DEVI
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MSTOM, LAC
Authorized Official - Phone:858-461-8538
Mailing Address - Street 1:7964 ARJONS DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4392
Mailing Address - Country:US
Mailing Address - Phone:858-461-8538
Mailing Address - Fax:858-530-0365
Practice Address - Street 1:7964 ARJONS DR
Practice Address - Street 2:SUITE D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4392
Practice Address - Country:US
Practice Address - Phone:858-461-8538
Practice Address - Fax:858-530-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13145171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588090054OtherINDIVIDUAL NPI