Provider Demographics
NPI:1831424704
Name:WHITNEY, TRACEY MARIE (LAC, HHP, LMT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:MARIE
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:LAC, HHP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15644 POMERADO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2419
Mailing Address - Country:US
Mailing Address - Phone:588-692-5221
Mailing Address - Fax:858-613-0794
Practice Address - Street 1:15644 POMERADO RD STE 102
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064
Practice Address - Country:US
Practice Address - Phone:588-692-5221
Practice Address - Fax:858-613-0794
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA18066171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty