Healthcare Provider Details

I. General information

NPI: 1992406367
Provider Name (Legal Business Name): TIERRA WHEATLEY DACM, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54240 RIDGEVIEW DR #101
IDYLLWILD CA
92549
US

IV. Provider business mailing address

PO BOX 173
IDYLLWILD CA
92549-0173
US

V. Phone/Fax

Practice location:
  • Phone: 520-808-8033
  • Fax:
Mailing address:
  • Phone: 520-808-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: