Provider Demographics
NPI:1659962876
Name:HERCEG, MASHIL CHEUNG (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:MASHIL
Middle Name:CHEUNG
Last Name:HERCEG
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:DR
Other - First Name:MASHIL
Other - Middle Name:
Other - Last Name:CHEUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DACM, LAC
Mailing Address - Street 1:1822 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1140
Mailing Address - Country:US
Mailing Address - Phone:760-642-9951
Mailing Address - Fax:
Practice Address - Street 1:1822 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1140
Practice Address - Country:US
Practice Address - Phone:760-642-9951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19001171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist