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General NPI Number Information
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NPI Number | 1992937072
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Entity Type | Individual
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Provider Name | ALYSSA DAZET
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Gender | Female
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 1150 YALE ST STE 8
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City | SANTA MONICA
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State | CA
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Zip | 90403-4768
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Country | US
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Telephone | 310-663-5831
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 BROCKTON AVE APT 5
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City | LOS ANGELES
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State | CA
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Zip | 90025-1346
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Country | US
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Telephone | 310-663-5831
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 14217
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License Number State | CA
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