Provider Demographics
NPI:1164581187
Name:GHAFFARIAN, MEHRDAD (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:GHAFFARIAN
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30212 TOMAS
Mailing Address - Street 2:SUITE 180
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2014
Mailing Address - Country:US
Mailing Address - Phone:949-206-1040
Mailing Address - Fax:949-713-9542
Practice Address - Street 1:30212 TOMAS
Practice Address - Street 2:SUITE 180
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2172
Practice Address - Country:US
Practice Address - Phone:949-206-1040
Practice Address - Fax:949-713-9542
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4762171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist