Provider Demographics
NPI:1346797966
Name:BURBANK ACUPUNCTURE CENTER
Entity Type:Organization
Organization Name:BURBANK ACUPUNCTURE CENTER
Other - Org Name:BURBANK ACUPUNCTURE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROOZBEH
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOBADPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-990-6433
Mailing Address - Street 1:2116 GLENOAKS BLVD.
Mailing Address - Street 2:UNIT 3
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91601
Mailing Address - Country:US
Mailing Address - Phone:310-990-6433
Mailing Address - Fax:
Practice Address - Street 1:4823 LEDGE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-4829
Practice Address - Country:US
Practice Address - Phone:310-990-6433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17720302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization