Provider Demographics
NPI:1215994496
Name:EISENSTARK, DOUGLAS D (LAC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:D
Last Name:EISENSTARK
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 1:11275 1/2 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11275 1/2 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4623
Practice Address - Country:US
Practice Address - Phone:310-403-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5444171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist