Provider Demographics
NPI:1477926137
Name:SHARAREH DAGHIGHI ACUPUNCTURE INC
Entity type:Organization
Organization Name:SHARAREH DAGHIGHI ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHARAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGHIGHI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-642-3512
Mailing Address - Street 1:16260 VENTURA BLVD STE LL16
Mailing Address - Street 2:SUITE LL16
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2223
Mailing Address - Country:US
Mailing Address - Phone:818-642-3512
Mailing Address - Fax:
Practice Address - Street 1:16260 VENTURA BLVD STE LL16
Practice Address - Street 2:SUITE LL16
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2223
Practice Address - Country:US
Practice Address - Phone:818-642-3512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE