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General NPI Number Information
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NPI Number | 1982148672
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Entity Type | Individual
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Provider Name | CRYSTAL ROSE TANK DAOM, LMP
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Gender | Female
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 3239 ADAMS AVE
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City | SAN DIEGO
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State | CA
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Zip | 92116-1645
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Country | US
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Telephone | 619-546-4806
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Fax |
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Provider Business Mailing Address
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Address Line | 3239 ADAMS AVE
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City | SAN DIEGO
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State | CA
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Zip | 92116-1645
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Country | US
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Telephone | 619-546-4806
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60723656
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA60448826
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 3134
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC20186
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License Number State | CA
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