Provider Demographics
NPI:1538427976
Name:EASTLAKE ACUPUNCTURE INC.
Entity type:Organization
Organization Name:EASTLAKE ACUPUNCTURE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST OWNER OF EAS
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYADI
Authorized Official - Suffix:
Authorized Official - Credentials:DTCM, LAC
Authorized Official - Phone:619-609-5300
Mailing Address - Street 1:4550 KEARNY VILLA RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:619-609-5300
Mailing Address - Fax:619-550-3269
Practice Address - Street 1:4550 KEARNY VILLA RD STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:619-609-5300
Practice Address - Fax:619-550-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14621171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty