Healthcare Provider Details

I. General information

NPI: 1629229703
Provider Name (Legal Business Name): PAUL DES ROSIERS L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 POTTER ST SUITE D
FALLBROOK CA
92028-3086
US

IV. Provider business mailing address

407 POTTER ST SUITE D
FALLBROOK CA
92028-3086
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-6557
  • Fax:
Mailing address:
  • Phone: 760-723-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA-7792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: