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General NPI Number Information
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NPI Number | 1972098671
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Entity Type | Individual
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Provider Name | AVISHAN SABERIAN LAC
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Gender | Female
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 05/19/2022
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Provider Practice Location Address
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Address Line | 110 W MAPLE STREE
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City | CENTRALIA
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State | WA
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Zip | 98531
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Country | US
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Telephone | 360-868-5025
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Fax | 360-868-5025
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Provider Business Mailing Address
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Address Line | 110 W MAPLE STREET
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City | CENTRALIA
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State | WA
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Zip | 98531
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Country | US
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Telephone | 360-868-4421
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Fax | 360-299-5025
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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 | AC60869961
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License Number State | WA
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