Provider Demographics
NPI:1144461781
Name:DAUPHIN, MEGAN ELIZABETH (LAC)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:DAUPHIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:BOSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:43353 MISSION BLVD # B
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5828
Mailing Address - Country:US
Mailing Address - Phone:831-428-5785
Mailing Address - Fax:510-952-4001
Practice Address - Street 1:43353 MISSION BLVD # B
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5828
Practice Address - Country:US
Practice Address - Phone:510-438-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13042171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist