Healthcare Provider Details

I. General information

NPI: 1679588016
Provider Name (Legal Business Name): MAHNAZ TAFRESHI ACUPUNCTURIEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 HOLT AVENUE
POMONA CA
91768
US

IV. Provider business mailing address

39 PARREMO
MISSION VIEJO CA
92692
US

V. Phone/Fax

Practice location:
  • Phone: 909-620-5699
  • Fax: 909-620-5799
Mailing address:
  • Phone: 949-581-8542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: