Provider Demographics
NPI:1568569036
Name:YAGOOBIAN, FARIBA CELINE (PHD, LAC, DOM)
Entity Type:Individual
Prefix:MRS
First Name:FARIBA
Middle Name:CELINE
Last Name:YAGOOBIAN
Suffix:
Gender:F
Credentials:PHD, LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15726 PARAMOUNT BLVD.
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-4333
Mailing Address - Country:US
Mailing Address - Phone:562-634-1000
Mailing Address - Fax:562-634-3048
Practice Address - Street 1:15726 PARAMOUNT BLVD.
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-4333
Practice Address - Country:US
Practice Address - Phone:562-634-1000
Practice Address - Fax:562-634-3048
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6612171100000X
NMD.O.M. LICENSE # 707171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0066120Medicaid