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General NPI Number Information
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NPI Number | 1134275951
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Entity Type | Individual
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Provider Name | AIDA AVANESIAN LAC
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 201 N BELMONT ST APT 104
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City | GLENDALE
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State | CA
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Zip | 91206-4925
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Country | US
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Telephone | 818-484-6342
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Fax |
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Provider Business Mailing Address
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Address Line | 5250 SANTA MONICA BLVD SUITE 304
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City | LOS ANGELES
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State | CA
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Zip | 90029
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Country | US
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Telephone | 323-953-1000
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Fax | 323-953-1000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 11057
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License Number State | CA
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