Healthcare Provider Details

I. General information

NPI: 1619345204
Provider Name (Legal Business Name): IRIS TANZ L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2015
Last Update Date: 09/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 WILSHIRE BLVD SUITE 270
BEVERLY HILLS CA
90211-1937
US

IV. Provider business mailing address

8907 WILSHIRE BLVD SUITE 270
BEVERLY HILLS CA
90211-1937
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-0022
  • Fax:
Mailing address:
  • Phone: 310-274-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: