Healthcare Provider Details

I. General information

NPI: 1245675271
Provider Name (Legal Business Name): SUZAN HASHEMI L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26740 TOWNE CENTRE DR
FOOTHILL RANCH CA
92610-2839
US

IV. Provider business mailing address

3 VERANO
FOOTHILL RANCH CA
92610-1827
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-9293
  • Fax: 949-588-0409
Mailing address:
  • Phone: 949-702-3344
  • Fax: 949-859-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: