Healthcare Provider Details

I. General information

NPI: 1568569036
Provider Name (Legal Business Name): FARIBA CELINE YAGOOBIAN PH.D., L.AC., D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15726 PARAMOUNT BLVD.
PARAMOUNT CA
90723-4333
US

IV. Provider business mailing address

15726 PARAMOUNT BLVD.
PARAMOUNT CA
90723-4333
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-1000
  • Fax: 562-634-3048
Mailing address:
  • Phone: 562-634-1000
  • Fax: 562-634-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6612
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberD.O.M. LICENSE # 707
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: