Healthcare Provider Details

I. General information

NPI: 1720907025
Provider Name (Legal Business Name): PINE AND TIDE A MARRIAGE AND FAMILY THERAPY PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 REGENTS RD STE 113-216
SAN DIEGO CA
92122-1937
US

IV. Provider business mailing address

7770 REGENTS RD STE 113-216
SAN DIEGO CA
92122-1937
US

V. Phone/Fax

Practice location:
  • Phone: 267-559-6602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANA PASCULESCU
Title or Position: OWNER
Credential:
Phone: 267-559-6602