Provider Demographics
NPI:1568672830
Name:SABOURI, MAHSHID (LAC)
Entity type:Individual
Prefix:MRS
First Name:MAHSHID
Middle Name:
Last Name:SABOURI
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 1:20841 VENTURA BLVD # 170
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2319
Mailing Address - Country:US
Mailing Address - Phone:818-274-4423
Mailing Address - Fax:
Practice Address - Street 1:6400 CANOGA AVE STE 333
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2492
Practice Address - Country:US
Practice Address - Phone:818-274-4423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10646171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist