Provider Demographics
NPI:1033756549
Name:AHADI, RANA (LAC)
Entity Type:Individual
Prefix:
First Name:RANA
Middle Name:
Last Name:AHADI
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 1:17199 W BERNARDO DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1539
Mailing Address - Country:US
Mailing Address - Phone:510-717-8555
Mailing Address - Fax:
Practice Address - Street 1:460 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6275
Practice Address - Country:US
Practice Address - Phone:510-717-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18702171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty