Provider Demographics
NPI:1306964150
Name:NASSERNIA, MAHNAZ (LAC PHD)
Entity type:Individual
Prefix:DR
First Name:MAHNAZ
Middle Name:
Last Name:NASSERNIA
Suffix:
Gender:F
Credentials:LAC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORPORATE PARK STE 168
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5161
Mailing Address - Country:US
Mailing Address - Phone:949-955-2655
Mailing Address - Fax:949-955-2699
Practice Address - Street 1:3 CORPORATE PARK STE 168
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5161
Practice Address - Country:US
Practice Address - Phone:949-955-2655
Practice Address - Fax:949-955-2699
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4591171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist