Healthcare Provider Details

I. General information

NPI: 1174415293
Provider Name (Legal Business Name): TRISTINE CILING DACCHM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23120 CARANCHO RD
TEMECULA CA
92590-4033
US

IV. Provider business mailing address

23120 CARANCHO RD
TEMECULA CA
92590-4033
US

V. Phone/Fax

Practice location:
  • Phone: 951-795-1277
  • Fax:
Mailing address:
  • Phone: 951-795-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: