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NPI Code Detail

MEDICARE: SVETLANA ARDANS SIDAKOVA L.AC., DIPL. AC.

MEDICARE: SVETLANA ARDANS SIDAKOVA L.AC., DIPL. AC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistLAC-010143AZ

General Provider Information

NPI Number : 1245820257
Entity Type Code : Individual
Provider Name (Legal Business Name) : SVETLANA ARDANS SIDAKOVA L.AC., DIPL. AC.
Provider Business Mailing Address
First Line : PO BOX 2635
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85252-2635
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2430 W RAY RD STE 1
Second Line :
City : CHANDLER
State : AZ
Zip : 85224-3552
Country : US
Telephone Number : 480-788-6432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2021
Last Update Date : 01/23/2021

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