=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568569036
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FARIBA CELINE YAGOOBIAN PH.D., L.AC., D.O.M.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15726 PARAMOUNT BLVD.
-----------------------------------------------------
City | PARAMOUNT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90723-4333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-634-1000
-----------------------------------------------------
Fax | 562-634-3048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15726 PARAMOUNT BLVD.
-----------------------------------------------------
City | PARAMOUNT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90723-4333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-634-1000
-----------------------------------------------------
Fax | 562-634-3048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC6612
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | D.O.M. LICENSE # 707
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------