Healthcare Provider Details

I. General information

NPI: 1831222322
Provider Name (Legal Business Name): JEANNETTE PAINOVICH MA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 EMERALD COVE WAY
SEAL BEACH CA
90740-6224
US

IV. Provider business mailing address

1510 EMERALD COVE WAY
SEAL BEACH CA
90740-6224
US

V. Phone/Fax

Practice location:
  • Phone: 310-963-3109
  • Fax:
Mailing address:
  • Phone: 310-963-3109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: