Provider Demographics
NPI:1316177140
Name:MAHBOUBI, ARTIN (LAC, DIPLAC)
Entity type:Individual
Prefix:
First Name:ARTIN
Middle Name:
Last Name:MAHBOUBI
Suffix:
Gender:M
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 OAK LEAF DR
Mailing Address - Street 2:SUITE 1813
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1317
Mailing Address - Country:US
Mailing Address - Phone:703-963-4555
Mailing Address - Fax:
Practice Address - Street 1:11215 OAK LEAF DR
Practice Address - Street 2:SUITE 1813
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1317
Practice Address - Country:US
Practice Address - Phone:703-963-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000542171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist