Provider Demographics
NPI:1760503411
Name:DURFEE, NORBERT R (LAC)
Entity Type:Individual
Prefix:MR
First Name:NORBERT
Middle Name:R
Last Name:DURFEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:BURT
Other - Middle Name:R
Other - Last Name:DURFEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:905 S LAKE ST
Mailing Address - Street 2:103
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2436
Mailing Address - Country:US
Mailing Address - Phone:818-842-4880
Mailing Address - Fax:818-842-4816
Practice Address - Street 1:905 S LAKE ST
Practice Address - Street 2:103
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2436
Practice Address - Country:US
Practice Address - Phone:818-842-4880
Practice Address - Fax:818-842-4816
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5792171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 5792OtherCA LICENSE ACUPUNCTURIST