Provider Demographics
NPI:1770993636
Name:DESTEFANO, JOSEPH MICHAEL II (DAOM, LAC, CMT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:DESTEFANO
Suffix:II
Gender:M
Credentials:DAOM, LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:18340 YORBA LINDA BLVD STE 107-405
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4058
Mailing Address - Country:US
Mailing Address - Phone:858-336-9139
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
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00454171100000X
CACMT 12010225700000X
CA16965171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist