Provider Demographics
NPI:1306428131
Name:DUFFIELD, GARY (L AC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:DUFFIELD
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 LOTUS PL
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2753
Mailing Address - Country:US
Mailing Address - Phone:714-747-9506
Mailing Address - Fax:
Practice Address - Street 1:121 W WHITTIER BLVD STE 222
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3893
Practice Address - Country:US
Practice Address - Phone:562-448-2311
Practice Address - Fax:562-393-6255
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18996171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist