MEDICARE: MS. SHOHREH DOUSTANI L.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
1	171100000X	Acupuncturist	CA10088	CA

General Provider Information

NPI Number	:	1407926942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHOHREH DOUSTANI L.AC.

Provider Business Mailing Address
First Line	:	4207 DUNDALK CT
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94566-4706
Country	:	US
Telephone Number	:	925-937-8123
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 SAN RAMON VALLEY BLVD
Second Line	:	SUITE 104
City	:	DANVILLE
State	:	CA
Zip	:	94526-4036
Country	:	US
Telephone Number	:	925-837-8123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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