Healthcare Provider Details

I. General information

NPI: 1972413151
Provider Name (Legal Business Name): AXEL JORDAN ALVAREZ DACCHM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41743 ENTERPRISE CIR N SUIT 107
TEMECULA CA
92590
US

IV. Provider business mailing address

223 E PARKRIDGE AVE APT B
CORONA CA
92879-1098
US

V. Phone/Fax

Practice location:
  • Phone: 800-595-2447
  • Fax:
Mailing address:
  • Phone: 951-640-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: