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NPI Code Detail

MEDICARE: WAYNE MARC STUPPEL L.AC.

MEDICARE: WAYNE MARC STUPPEL L.AC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistAC6393CA

General Provider Information

NPI Number : 1366523631
Entity Type Code : Individual
Provider Name (Legal Business Name) : WAYNE MARC STUPPEL L.AC.
Provider Business Mailing Address
First Line : 1515 S GENESEE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90019-3811
Country : US
Telephone Number : 310-801-4154
Fax Number :
Provider Business Practice Location Address
First Line : 1515 S GENESEE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90019-3811
Country : US
Telephone Number : 310-801-4154
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 09/13/2023

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Directions to “ WAYNE MARC STUPPEL L.AC.” Practice Location

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