Provider Demographics
NPI:1114064094
Name:HAUG, KRISTINE (LAC, DIPL AC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:HAUG
Suffix:
Gender:F
Credentials:LAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2778 POWHATAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2420
Mailing Address - Country:US
Mailing Address - Phone:858-945-3958
Mailing Address - Fax:
Practice Address - Street 1:12889 RANCHO PENASQUITOS BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2934
Practice Address - Country:US
Practice Address - Phone:858-538-8699
Practice Address - Fax:858-538-8899
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10024171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist