Healthcare Provider Details

I. General information

NPI: 1992840664
Provider Name (Legal Business Name): GRACE SOLTYNSKI DAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33971 SELVA RD STE 110
DANA POINT CA
92629-3788
US

IV. Provider business mailing address

29151 KENSINGTON DR
LAGUNA NIGUEL CA
92677-1601
US

V. Phone/Fax

Practice location:
  • Phone: 949-240-7773
  • Fax: 949-481-1990
Mailing address:
  • Phone: 949-285-1914
  • Fax: 949-481-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: