Provider Demographics
NPI:1639495302
Name:AVETIAN, LIANA VICTORIA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LIANA
Middle Name:VICTORIA
Last Name:AVETIAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:LIANA
Other - Middle Name:VICTORIA
Other - Last Name:SARKISOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:97 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1116
Mailing Address - Country:US
Mailing Address - Phone:339-225-1234
Mailing Address - Fax:
Practice Address - Street 1:575 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3607
Practice Address - Country:US
Practice Address - Phone:617-778-7344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237924171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist