Provider Demographics
NPI:1215758958
Name:STRONG, TRACY (DACM)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:STRONG
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6391 GLENMONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4711
Mailing Address - Country:US
Mailing Address - Phone:619-379-9063
Mailing Address - Fax:
Practice Address - Street 1:2729 4TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6223
Practice Address - Country:US
Practice Address - Phone:619-790-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20203171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist