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General NPI Number Information
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NPI Number | 1548714678
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Entity Type | Individual
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Provider Name | PALERATH NATALIE JIARAVANONT LAC.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 13315 W WASHINGTON BLVD SUITE 304
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City | LOS ANGELES
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State | CA
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Zip | 90066-5169
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Country | US
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Telephone | 646-792-6313
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Fax |
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Provider Business Mailing Address
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Address Line | 12924 DISCOVERY CRK
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City | PLAYA VISTA
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State | CA
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Zip | 90094-2207
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Country | US
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Telephone | 646-729-6313
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Fax |
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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 | 14970
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License Number State | CA
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