Provider Demographics
NPI:1467096172
Name:DUNDAS, RENEE ALENE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ALENE
Last Name:DUNDAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3856 LYCEUM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4125
Mailing Address - Country:US
Mailing Address - Phone:310-962-8497
Mailing Address - Fax:
Practice Address - Street 1:3856 LYCEUM AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-4125
Practice Address - Country:US
Practice Address - Phone:310-962-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05201225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist