Healthcare Provider Details

I. General information

NPI: 1710801543
Provider Name (Legal Business Name): LARA DANIELLE GROSSMITH DACCHM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 OBERLIN DR STE 316A
SAN DIEGO CA
92121-1786
US

IV. Provider business mailing address

7740 PARKWAY DR UNIT 207
LA MESA CA
91942-4611
US

V. Phone/Fax

Practice location:
  • Phone: 619-800-8492
  • Fax:
Mailing address:
  • Phone: 609-658-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC20524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: