Provider Demographics
NPI:1922304674
Name:COBB, AYANNA (DACM LAC)
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:
Last Name:COBB
Suffix:
Gender:F
Credentials:DACM LAC
Other - Prefix:
Other - First Name:AYANNA
Other - Middle Name:
Other - Last Name:COBB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DACM,ABT, HHP, LAC
Mailing Address - Street 1:4641 CALLE DE CASITAS
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-5212
Mailing Address - Country:US
Mailing Address - Phone:760-331-4271
Mailing Address - Fax:760-547-5433
Practice Address - Street 1:2890 PIO PICO DR STE 104
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1558
Practice Address - Country:US
Practice Address - Phone:760-331-4271
Practice Address - Fax:760-547-5433
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570204-09225700000X
CA16958171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist