Provider Demographics
NPI:1114706090
Name:CORI, PARISA (LAC)
Entity Type:Individual
Prefix:DR
First Name:PARISA
Middle Name:
Last Name:CORI
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:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-1052
Mailing Address - Country:US
Mailing Address - Phone:408-827-5293
Mailing Address - Fax:
Practice Address - Street 1:114 ROYCE ST STE E
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6041
Practice Address - Country:US
Practice Address - Phone:408-827-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19476171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty