Provider Demographics
NPI:1932392297
Name:VUKMANIC, WILL (L AC)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:
Last Name:VUKMANIC
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 W POINT LOMA BLVD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1024
Mailing Address - Country:US
Mailing Address - Phone:619-296-9609
Mailing Address - Fax:
Practice Address - Street 1:4444 W POINT LOMA BLVD UNIT 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-1024
Practice Address - Country:US
Practice Address - Phone:619-296-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11235171100000X
AZ674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist