Healthcare Provider Details

I. General information

NPI: 1649508151
Provider Name (Legal Business Name): RAINA TSUDA DAOM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W 1ST ST
TUSTIN CA
92780-3004
US

IV. Provider business mailing address

28985 OAK CREEK LN APT 2310
AGOURA HILLS CA
91301-6442
US

V. Phone/Fax

Practice location:
  • Phone: 714-386-9363
  • Fax:
Mailing address:
  • Phone: 714-392-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13122
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: