Provider Demographics
NPI:1174933006
Name:RESSNER, SIMONE (LAC, DIPL OM, CMT)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:RESSNER
Suffix:
Gender:F
Credentials:LAC, DIPL OM, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14250 MIRA ZANJA CORTE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1630
Mailing Address - Country:US
Mailing Address - Phone:916-538-1466
Mailing Address - Fax:
Practice Address - Street 1:14250 MIRA ZANJA CORTE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1630
Practice Address - Country:US
Practice Address - Phone:916-538-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15763171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist