Healthcare Provider Details

I. General information

NPI: 1184547655
Provider Name (Legal Business Name): ATISA RASHIDI L.AC, DTCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 W FOOTHILL BLVD
UPLAND CA
91786-3804
US

IV. Provider business mailing address

1408 FOREST ST
UPLAND CA
91784-1092
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-4001
  • Fax: 909-982-4002
Mailing address:
  • Phone: 909-240-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC20694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: