Provider Demographics
NPI:1053867366
Name:DONNA DUPRE, LIC. AC.,DAOM, A PROFESSIONAL ACUPUNCTURE CORPORATION
Entity Type:Organization
Organization Name:DONNA DUPRE, LIC. AC.,DAOM, A PROFESSIONAL ACUPUNCTURE CORPORATION
Other - Org Name:DONNA DUPRE, L.AC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPRE
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC, DAOM
Authorized Official - Phone:818-563-9453
Mailing Address - Street 1:4444 W RIVERSIDE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4073
Mailing Address - Country:US
Mailing Address - Phone:818-563-9453
Mailing Address - Fax:818-563-9595
Practice Address - Street 1:4444 W RIVERSIDE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4073
Practice Address - Country:US
Practice Address - Phone:818-563-9453
Practice Address - Fax:818-563-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC770171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty