Provider Demographics
NPI:1558524165
Name:ADVANI, PRIYA (PRIYA ADVANI, LAC)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:ADVANI
Suffix:
Gender:F
Credentials:PRIYA ADVANI, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S BARRINGTON AVE
Mailing Address - Street 2:UNIT 1112
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4333
Mailing Address - Country:US
Mailing Address - Phone:310-463-8323
Mailing Address - Fax:
Practice Address - Street 1:2001 S BARRINGTON AVE STE 112
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5337
Practice Address - Country:US
Practice Address - Phone:310-463-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
CA12257171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education