Provider Demographics
NPI:1861075046
Name:WELLS, EMILY (LAC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4096 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2108
Mailing Address - Country:US
Mailing Address - Phone:904-333-5001
Mailing Address - Fax:
Practice Address - Street 1:444 S CEDROS AVE
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1980
Practice Address - Country:US
Practice Address - Phone:760-566-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty