Healthcare Provider Details

I. General information

NPI: 1609354661
Provider Name (Legal Business Name): IRENE SHABZI ROWLAND LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 PARK SPRINGS CT
OAK PARK CA
91377-3817
US

IV. Provider business mailing address

506 PARK SPRINGS CT
OAK PARK CA
91377-3817
US

V. Phone/Fax

Practice location:
  • Phone: 818-966-9061
  • Fax:
Mailing address:
  • Phone: 818-966-9061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: