Provider Demographics
NPI:1205160892
Name:LEUCADIA FAMILY ACUPUNCTURE
Entity type:Organization
Organization Name:LEUCADIA FAMILY ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:760-943-7667
Mailing Address - Street 1:1114 NORTH COAST HIGHWAY,
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-943-7667
Mailing Address - Fax:760-943-7667
Practice Address - Street 1:1114 NORTH COAST HIGHWAY,
Practice Address - Street 2:SUITE 1A
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-943-7667
Practice Address - Fax:760-943-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12901171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty