Provider Demographics
NPI:1265975585
Name:JOSEPH M. DESTEFANO II, D.AC., L.AC.
Entity type:Organization
Organization Name:JOSEPH M. DESTEFANO II, D.AC., L.AC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DE STEFANO
Authorized Official - Suffix:II
Authorized Official - Credentials:DAC, LAC
Authorized Official - Phone:310-853-0784
Mailing Address - Street 1:8701 TRUXTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3911
Mailing Address - Country:US
Mailing Address - Phone:310-853-0784
Mailing Address - Fax:310-307-2989
Practice Address - Street 1:8701 TRUXTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3911
Practice Address - Country:US
Practice Address - Phone:310-853-0784
Practice Address - Fax:310-307-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00454171100000X
CACMT12010225700000X
CAAC16965171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty