Healthcare Provider Details

I. General information

NPI: 1053235895
Provider Name (Legal Business Name): POKE-AHA-NTAS ACUPUNCTURE, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. LARA DANIELLE GROSSMITH
Title or Position: PRESIDENT
Credential: DACCHM, L.AC.
Phone: 619-800-8492