Healthcare Provider Details

I. General information

NPI: 1013847474
Provider Name (Legal Business Name): DOUGLAS GIVIN-DUNLAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DOUG DUNLAP

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 WALTER AVE
NEWBURY PARK CA
91320-5068
US

IV. Provider business mailing address

544 WALTER AVE
NEWBURY PARK CA
91320-5068
US

V. Phone/Fax

Practice location:
  • Phone: 805-573-0071
  • Fax:
Mailing address:
  • Phone: 805-573-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number92653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: