Provider Demographics
NPI:1477730067
Name:KUPPERMAN, STACEY DEE (ND)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DEE
Last Name:KUPPERMAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 CAHUENGA BLVD W STE 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1359
Mailing Address - Country:US
Mailing Address - Phone:310-310-9717
Mailing Address - Fax:310-496-1779
Practice Address - Street 1:3535 CAHUENGA BLVD W STE 206
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1359
Practice Address - Country:US
Practice Address - Phone:310-310-9717
Practice Address - Fax:310-496-1779
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6784269-7101175F00000X
CAND-342175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath