Provider Demographics
NPI:1508914128
Name:GROSSMONT MEDICAL CENTER ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:GROSSMONT MEDICAL CENTER ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GHASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:619-465-8800
Mailing Address - Street 1:5565 GROSSMONT CENTER DR STE 500 BLDG 3
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3024
Mailing Address - Country:US
Mailing Address - Phone:619-465-8800
Mailing Address - Fax:619-465-8808
Practice Address - Street 1:5565 GROSSMONT CENTER DR STE 500 BLDG 3
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3024
Practice Address - Country:US
Practice Address - Phone:619-465-8800
Practice Address - Fax:619-465-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty