Provider Demographics
NPI:1457700213
Name:DUBOIS, ROBERT WILEY (LAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILEY
Last Name:DUBOIS
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 1:3300 KINGSLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2603
Mailing Address - Country:US
Mailing Address - Phone:603-534-3251
Mailing Address - Fax:
Practice Address - Street 1:2615 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2200
Practice Address - Country:US
Practice Address - Phone:603-534-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16909171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist