Healthcare Provider Details

I. General information

NPI: 1467225771
Provider Name (Legal Business Name): DEENA PASTORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HIGH BLUFF DR STE 103
SAN DIEGO CA
92130-2053
US

IV. Provider business mailing address

2367 CADDIE CT
OCEANSIDE CA
92056-1708
US

V. Phone/Fax

Practice location:
  • Phone: 858-461-9920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: