Healthcare Provider Details

I. General information

NPI: 1417737933
Provider Name (Legal Business Name): VIRGINIA HYANNIS LEE DACM, LAC, DIPL. O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CAMINO DEL RIO S #315
SAN DIEGO CA
92108
US

IV. Provider business mailing address

2525 CAMINO DEL RIO S #315
SAN DIEGO CA
92108-1213
US

V. Phone/Fax

Practice location:
  • Phone: 858-356-2286
  • Fax:
Mailing address:
  • Phone: 858-356-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: