Provider Demographics
NPI:1629232640
Name:HOWARD, TINA PATRICE (MSTOM, LAC)
Entity type:Individual
Prefix:MISS
First Name:TINA
Middle Name:PATRICE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MSTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7830 CLAIREMONT MESA BLVD STE 287
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1619
Mailing Address - Country:US
Mailing Address - Phone:760-436-9336
Mailing Address - Fax:858-751-0569
Practice Address - Street 1:7830 CLAIREMONT MESA BLVD STE 287
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1619
Practice Address - Country:US
Practice Address - Phone:760-436-9336
Practice Address - Fax:858-751-0569
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12323171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist