Provider Demographics
NPI:1275200065
Name:DUNN, MICHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:3796 DOVE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3979
Mailing Address - Country:US
Mailing Address - Phone:305-494-3032
Mailing Address - Fax:
Practice Address - Street 1:3645 RUFFIN RD STE 315
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1868
Practice Address - Country:US
Practice Address - Phone:619-917-2958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18893171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty