Provider Demographics
NPI:1487945226
Name:CARLSBAD FAMILY ACUPUNCTURE
Entity type:Organization
Organization Name:CARLSBAD FAMILY ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOULTBEE-WINGO
Authorized Official - Suffix:
Authorized Official - Credentials:MSTOM, LAC
Authorized Official - Phone:760-729-0115
Mailing Address - Street 1:329 MOONSTONE BAY DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-3426
Mailing Address - Country:US
Mailing Address - Phone:760-729-0115
Mailing Address - Fax:760-729-0110
Practice Address - Street 1:1207 CARLSBAD VILLAGE DR STE Y
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1958
Practice Address - Country:US
Practice Address - Phone:760-729-0115
Practice Address - Fax:760-729-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12384171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty