Provider Demographics
NPI:1275721003
Name:DENNETT, SUSAN DRAKE (L AC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DRAKE
Last Name:DENNETT
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 N EL CAMINO REAL STE C
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2859
Mailing Address - Country:US
Mailing Address - Phone:760-479-0009
Mailing Address - Fax:
Practice Address - Street 1:274 N EL CAMINO REAL STE C
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2859
Practice Address - Country:US
Practice Address - Phone:760-479-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5198171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist