Provider Demographics
NPI:1598057697
Name:GRONDAL, EINAR (L AC)
Entity Type:Individual
Prefix:MR
First Name:EINAR
Middle Name:
Last Name:GRONDAL
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 ESSEX ST
Mailing Address - Street 2:# 1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3324
Mailing Address - Country:US
Mailing Address - Phone:619-688-2480
Mailing Address - Fax:
Practice Address - Street 1:1241 ESSEX ST
Practice Address - Street 2:# 1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3324
Practice Address - Country:US
Practice Address - Phone:619-688-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-07
Last Update Date:2011-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7948171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist