Provider Demographics
NPI:1356095327
Name:YEPES, LUIS FABIAN (LAC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FABIAN
Last Name:YEPES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-0031
Mailing Address - Country:US
Mailing Address - Phone:631-406-0043
Mailing Address - Fax:
Practice Address - Street 1:648 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8761
Practice Address - Country:US
Practice Address - Phone:631-849-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty