Provider Demographics
NPI:1780894832
Name:AMATO, DAVID IAN (LAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:IAN
Last Name:AMATO
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:1075 HENRY RIDGE MTWY
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-4138
Mailing Address - Country:US
Mailing Address - Phone:310-729-8369
Mailing Address - Fax:310-447-1864
Practice Address - Street 1:11633 SAN VICENTE BLVD
Practice Address - Street 2:#220
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6511
Practice Address - Country:US
Practice Address - Phone:310-826-7597
Practice Address - Fax:310-447-1864
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC11031171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist