Provider Demographics
NPI:1528397650
Name:TAJIRIAN, ARDEMIS (L AC)
Entity Type:Individual
Prefix:MRS
First Name:ARDEMIS
Middle Name:
Last Name:TAJIRIAN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 30TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3424
Mailing Address - Country:US
Mailing Address - Phone:510-465-6700
Mailing Address - Fax:510-465-7765
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-465-6700
Practice Address - Fax:510-465-7765
Is Sole Proprietor?:No
Enumeration Date:2009-12-20
Last Update Date:2009-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12440171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist