Provider Demographics
NPI:1932131539
Name:PACIFIC CENTER OF HEALTH AND ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:PACIFIC CENTER OF HEALTH AND ACUPUNCTURE, INC.
Other - Org Name:PACIFIC CENTER OF HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:619-542-0884
Mailing Address - Street 1:2615 CAMINO DEL RIO S. #201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-542-0884
Mailing Address - Fax:619-542-0949
Practice Address - Street 1:2615 CAMINO DEL RIO S. #201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-542-0884
Practice Address - Fax:619-542-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66200ZOtherBLUE SHIELD ID