Provider Demographics
NPI:1902916398
Name:FUSCO, HENRY (LAC)
Entity Type:Individual
Prefix:MISS
First Name:HENRY
Middle Name:
Last Name:FUSCO
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 1:3670 CLAIREMONT DR
Mailing Address - Street 2:STE.11
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5911
Mailing Address - Country:US
Mailing Address - Phone:858-483-0102
Mailing Address - Fax:
Practice Address - Street 1:3670 CLAIREMONT DR
Practice Address - Street 2:STE.11
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5911
Practice Address - Country:US
Practice Address - Phone:858-483-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist