Provider Demographics
NPI:1790912459
Name:WRIGHT, DANA (LAC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WASHINGTON BLVD
Mailing Address - Street 2:#134
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5136
Mailing Address - Country:US
Mailing Address - Phone:310-482-9968
Mailing Address - Fax:
Practice Address - Street 1:333 WASHINGTON BLVD
Practice Address - Street 2:#134
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5136
Practice Address - Country:US
Practice Address - Phone:310-482-9968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12986171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist