Provider Demographics
NPI:1609150630
Name:MEYEROWITZ, ADAM ETAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:ETAN
Last Name:MEYEROWITZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13310 VIA MAGDALENA UNIT 6
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4692
Mailing Address - Country:US
Mailing Address - Phone:858-255-1836
Mailing Address - Fax:
Practice Address - Street 1:11300 SORRENTO VALLEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1328
Practice Address - Country:US
Practice Address - Phone:858-255-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14407171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist