Provider Demographics
NPI:1588087274
Name:GERTZKI, OLIVER (LAC)
Entity type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:
Last Name:GERTZKI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 ENCINITAS BLVD STE 316
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3762
Mailing Address - Country:US
Mailing Address - Phone:760-282-4594
Mailing Address - Fax:760-632-6980
Practice Address - Street 1:681 ENCINITAS BLVD STE 316
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3762
Practice Address - Country:US
Practice Address - Phone:760-282-4594
Practice Address - Fax:760-632-6980
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15545171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist