Provider Demographics
NPI:1902126345
Name:AYSON, JUANITA (LAC)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:AYSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:
Other - Last Name:AYSON-BEANUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:333 S JUNIPER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4924
Mailing Address - Country:US
Mailing Address - Phone:760-214-6546
Mailing Address - Fax:760-738-1645
Practice Address - Street 1:333 S JUNIPER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4924
Practice Address - Country:US
Practice Address - Phone:760-214-6546
Practice Address - Fax:760-738-1645
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist