MEDICARE: AIDA AVANESIAN LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC 11057	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134275951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIDA AVANESIAN LAC

Provider Business Mailing Address
First Line	:	5250 SANTA MONICA BLVD
Second Line	:	SUITE 304
City	:	LOS ANGELES
State	:	CA
Zip	:	90029
Country	:	US
Telephone Number	:	323-953-1000
Fax Number	:	323-953-1000

Provider Business Practice Location Address
First Line	:	201 N BELMONT ST
Second Line	:	APT 104
City	:	GLENDALE
State	:	CA
Zip	:	91206-4925
Country	:	US
Telephone Number	:	818-484-6342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	05/29/2008

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