Provider Demographics
NPI:1780606095
Name:TEIXEIRA, M DAVID (LAC)
Entity type:Individual
Prefix:MR
First Name:M
Middle Name:DAVID
Last Name:TEIXEIRA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2707 CAMULOS ST
Mailing Address - Street 2:APT # 7
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1160
Mailing Address - Country:US
Mailing Address - Phone:619-200-1522
Mailing Address - Fax:
Practice Address - Street 1:3320 3RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5683
Practice Address - Country:US
Practice Address - Phone:619-200-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8821171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist