Healthcare Provider Details

I. General information

NPI: 1033959929
Provider Name (Legal Business Name): DAUPHIN INTEGRATIVE GYNECOLOGY & WOMEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 VAN NUYS BLVD STE 306
SHERMAN OAKS CA
91403-1800
US

IV. Provider business mailing address

254 N LAKE AVE # 235
PASADENA CA
91101-1829
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-6101
  • Fax:
Mailing address:
  • Phone: 818-397-5407
  • Fax: 877-297-4486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSELINE MARIE DAUPHIN
Title or Position: PRESIDENT/CEO
Credential: M.D
Phone: 818-397-5407