Provider Demographics
NPI:1386091502
Name:JIWANI, NOORANI (LAC, DAOM)
Entity type:Individual
Prefix:
First Name:NOORANI
Middle Name:
Last Name:JIWANI
Suffix:
Gender:F
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BRIDGEPORT ST
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3257
Mailing Address - Country:US
Mailing Address - Phone:818-288-4178
Mailing Address - Fax:
Practice Address - Street 1:34052 LA PLZ STE 102
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2571
Practice Address - Country:US
Practice Address - Phone:949-218-2097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16838171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist