=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215825419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REGINA PASKOFF DACCHM, MSTOM, LAC
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2025
-----------------------------------------------------
Last Update Date | 06/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2970 FIFTH AVE STE 320
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92103-5995
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-333-7688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4315 MENTONE ST
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92107-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-804-2602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 20244
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------