Provider Demographics
NPI:1972060325
Name:KREPPER, VINCIANE (LAC)
Entity type:Individual
Prefix:MRS
First Name:VINCIANE
Middle Name:
Last Name:KREPPER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7751 JOSHUA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3912
Mailing Address - Country:US
Mailing Address - Phone:310-463-4536
Mailing Address - Fax:
Practice Address - Street 1:1514 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3442
Practice Address - Country:US
Practice Address - Phone:310-463-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18350171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist