Provider Demographics
NPI:1407926942
Name:DOUSTANI, SHOHREH (LAC)
Entity Type:Individual
Prefix:MS
First Name:SHOHREH
Middle Name:
Last Name:DOUSTANI
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 1:4207 DUNDALK CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4706
Mailing Address - Country:US
Mailing Address - Phone:925-937-8123
Mailing Address - Fax:
Practice Address - Street 1:907 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4036
Practice Address - Country:US
Practice Address - Phone:925-837-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA10088171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist