Healthcare Provider Details

I. General information

NPI: 1053228114
Provider Name (Legal Business Name): BENJAMIN JAMES FISH DACCHM., LAC., CMT.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7185 NAVAJO RD STE A
SAN DIEGO CA
92119-1648
US

IV. Provider business mailing address

7275 STANFORD AVE
LA MESA CA
91942-8759
US

V. Phone/Fax

Practice location:
  • Phone: 619-356-3931
  • Fax:
Mailing address:
  • Phone: 818-825-9793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC20658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: