Healthcare Provider Details

I. General information

NPI: 1477730067
Provider Name (Legal Business Name): STACEY DEE KUPPERMAN N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 1/2 W RIVERSIDE DR
BURBANK CA
91505-4044
US

IV. Provider business mailing address

8023 BEVERLY BLVD STE 1-532
LOS ANGELES CA
90048-4539
US

V. Phone/Fax

Practice location:
  • Phone: 310-310-9717
  • Fax: 310-496-1779
Mailing address:
  • Phone: 310-310-9717
  • Fax: 310-496-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-342
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number6784269-7101
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number24-1855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: