Provider Demographics
NPI:1962150656
Name:ERADAT, LEAH (LAC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ERADAT
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 1:18102 BURBANK BLVD UNIT 32
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2523
Mailing Address - Country:US
Mailing Address - Phone:424-235-7988
Mailing Address - Fax:
Practice Address - Street 1:18102 BURBANK BLVD UNIT 32
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2523
Practice Address - Country:US
Practice Address - Phone:424-235-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19232171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist