Healthcare Provider Details

I. General information

NPI: 1346488673
Provider Name (Legal Business Name): ROBIN KENDALL CUPP L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13416 N 32ND ST SUITE 104
PHOENIX AZ
85032-6000
US

IV. Provider business mailing address

13416 N 32ND ST SUITE 104
PHOENIX AZ
85032-6000
US

V. Phone/Fax

Practice location:
  • Phone: 520-400-4625
  • Fax:
Mailing address:
  • Phone: 520-400-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0342
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: