Organization Name: | DALE PROKUPEK MD INC |
NPI Number: | 1548569197 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DALE A PROKUPEK (OWNER) |
Mailing Address: | 8641 Wilshire Blvd 100 Beverly Hills |
State: | CA US |
Postal Code: | 902112900 |
Phone Number: | 3103606807 |
Fax Number: | 3103606683 |
NPI Enumeration Date: | 03/22/2011 |
NPI Last Update Date: | 03/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G71035 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |