Provider Demographics
NPI:1336693670
Name:ROUHANI, SHIVA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SHIVA
Middle Name:
Last Name:ROUHANI
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 1:1740 W CAMERON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2719
Mailing Address - Country:US
Mailing Address - Phone:949-395-1141
Mailing Address - Fax:626-337-8701
Practice Address - Street 1:1740 W CAMERON AVE STE 102
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2719
Practice Address - Country:US
Practice Address - Phone:949-395-1141
Practice Address - Fax:626-337-8701
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16889171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist