Provider Demographics
NPI:1225300809
Name:TARVER, NOEL KAORI (LAC)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:KAORI
Last Name:TARVER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KAORI
Other - Middle Name:
Other - Last Name:WATANABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:4388 ARAGON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5912
Mailing Address - Country:US
Mailing Address - Phone:808-234-9551
Mailing Address - Fax:
Practice Address - Street 1:10330 FRIARS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2341
Practice Address - Country:US
Practice Address - Phone:808-234-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU 1021171100000X
CAAC 14052171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist