Healthcare Provider Details

I. General information

NPI: 1205110012
Provider Name (Legal Business Name): TATYANA DRAGUNAS L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 SAN VICENTE BLVD # 220
LOS ANGELES CA
90048-5426
US

IV. Provider business mailing address

6310 SAN VICENTE BLVD # 220
LOS ANGELES CA
90048-5426
US

V. Phone/Fax

Practice location:
  • Phone: 310-309-1281
  • Fax:
Mailing address:
  • Phone: 310-309-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: