Provider Demographics
NPI:1619012549
Name:KRECU, LEAH DAVIDA (LAC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:DAVIDA
Last Name:KRECU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2210 ENCINITAS BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4358
Mailing Address - Country:US
Mailing Address - Phone:760-632-7728
Mailing Address - Fax:760-632-7730
Practice Address - Street 1:2210 ENCINITAS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4358
Practice Address - Country:US
Practice Address - Phone:760-632-7728
Practice Address - Fax:760-632-7730
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5958171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist