Provider Demographics
NPI:1427405190
Name:GREENBERG, TARA (LAC, DIPL OM)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 VANDERBILT LN
Mailing Address - Street 2:UNIT 3
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3058
Mailing Address - Country:US
Mailing Address - Phone:424-290-0970
Mailing Address - Fax:
Practice Address - Street 1:2016 VANDERBILT LN
Practice Address - Street 2:UNIT 3
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3058
Practice Address - Country:US
Practice Address - Phone:424-290-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist