Active NPI
Dana Michelle Boldt, L.AC.
- Acupuncturist
- Los Angeles, CA
National Provider Identifier
1649457565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 11902
- Practice address
- 12114 Venice Blvd
Los Angeles, CA 90066-3812 - Phone
- (310) 397-6001
- NPI assigned
- Jan 22, 2008
- Last updated
- Jan 22, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 11902 | CA | Primary |
Addresses
Primary practice location
12114 Venice Blvd
Los Angeles, CA 90066-3812
Mailing address
859 25TH St
Santa Monica, CA 90403-2107
Phone (213) 400-7700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11902 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200960000000",
"number": "1649457565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "859 25TH ST",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904032107",
"telephone_number": "213-400-7700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12114 VENICE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900663812",
"telephone_number": "310-397-6001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDT",
"first_name": "DANA",
"middle_name": "MICHELLE",
"credential": "L.AC.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-22",
"last_updated": "2008-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "11902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.