Provider Demographics
NPI:1932298015
Name:ASANO, NOBUYOSHI (LAC OMD)
Entity Type:Individual
Prefix:
First Name:NOBUYOSHI
Middle Name:
Last Name:ASANO
Suffix:
Gender:M
Credentials:LAC OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4549
Mailing Address - Country:US
Mailing Address - Phone:760-944-6039
Mailing Address - Fax:760-753-4146
Practice Address - Street 1:515 ENCINITAS BLVD
Practice Address - Street 2:#101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3737
Practice Address - Country:US
Practice Address - Phone:760-753-8857
Practice Address - Fax:760-753-4146
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist