Healthcare Provider Details

I. General information

NPI: 1942819321
Provider Name (Legal Business Name): CINDY DUPUIE STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18010 SKY PARK CIR STE 290
IRVINE CA
92614-6487
US

IV. Provider business mailing address

PO BOX 7102
NEWPORT BEACH CA
92658-7102
US

V. Phone/Fax

Practice location:
  • Phone: 949-370-9843
  • Fax:
Mailing address:
  • Phone: 949-370-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: