Healthcare Provider Details

I. General information

NPI: 1467994632
Provider Name (Legal Business Name): BENITA SAFARYANS ABORM, DAOM, LAC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE STE 300
GLENDALE CA
91204-2587
US

IV. Provider business mailing address

1500 S CENTRAL AVE STE 300
GLENDALE CA
91204-2587
US

V. Phone/Fax

Practice location:
  • Phone: 818-823-6721
  • Fax:
Mailing address:
  • Phone: 818-823-6721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 17332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: