Provider Demographics
NPI:1952830275
Name:SYNTRUVIA
Entity Type:Organization
Organization Name:SYNTRUVIA
Other - Org Name:CRIS OCTA DEL ROSARIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OCTA DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:858-531-2586
Mailing Address - Street 1:5663 BALBOA AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2705
Mailing Address - Country:US
Mailing Address - Phone:858-531-2586
Mailing Address - Fax:
Practice Address - Street 1:4780 MISSION GORGE PL STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4229
Practice Address - Country:US
Practice Address - Phone:858-531-2586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16435171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty