Provider Demographics
NPI:1306331731
Name:BERISTAIN, YUNUEN (LAC)
Entity type:Individual
Prefix:MS
First Name:YUNUEN
Middle Name:
Last Name:BERISTAIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 W MANCHESTER AVE APT 441
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3847
Mailing Address - Country:US
Mailing Address - Phone:818-428-9858
Mailing Address - Fax:
Practice Address - Street 1:7270 W MANCHESTER AVE APT 441
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3847
Practice Address - Country:US
Practice Address - Phone:818-428-9858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17554171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC17554OtherSTATE OF CALIFORNIA ACUPUNCTURE BOARD