Provider Demographics
NPI:1649508151
Name:TSUDA, RAINA (DAOM, LAC)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:TSUDA
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28985 OAK CREEK LN APT 2310
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-6442
Mailing Address - Country:US
Mailing Address - Phone:714-392-5656
Mailing Address - Fax:
Practice Address - Street 1:505 W 1ST ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3004
Practice Address - Country:US
Practice Address - Phone:714-386-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
CA13122171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist