Healthcare Provider Details

I. General information

NPI: 1255177325
Provider Name (Legal Business Name): CHRISTIANE STEFANOFF DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W E ST
ENCINITAS CA
92024-3520
US

IV. Provider business mailing address

121 W E ST
ENCINITAS CA
92024-3520
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-1128
  • Fax:
Mailing address:
  • Phone: 760-942-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: