Healthcare Provider Details

I. General information

NPI: 1053867366
Provider Name (Legal Business Name): DONNA DUPRE, LIC. AC.,DAOM, A PROFESSIONAL ACUPUNCTURE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2016
Last Update Date: 08/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 W RIVERSIDE DR SUITE 108
BURBANK CA
91505-4073
US

IV. Provider business mailing address

4444 W RIVERSIDE DR SUITE 108
BURBANK CA
91505-4073
US

V. Phone/Fax

Practice location:
  • Phone: 818-563-9453
  • Fax: 818-563-9595
Mailing address:
  • Phone: 818-563-9453
  • Fax: 818-563-9595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC770
License Number StateCA

VIII. Authorized Official

Name: DONNA DUPRE
Title or Position: PRESIDENT
Credential: LIC AC, DAOM
Phone: 818-563-9453