Healthcare Provider Details

I. General information

NPI: 1306428131
Provider Name (Legal Business Name): GARY DUFFIELD L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W WHITTIER BLVD STE 222
LA HABRA CA
90631-3893
US

IV. Provider business mailing address

1822 LOTUS PL
BREA CA
92821-2753
US

V. Phone/Fax

Practice location:
  • Phone: 562-448-2311
  • Fax: 562-393-6255
Mailing address:
  • Phone: 714-747-9506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: