Provider Demographics
NPI:1679588016
Name:TAFRESHI, MAHNAZ (ACUPUNCTURIEST)
Entity Type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:
Last Name:TAFRESHI
Suffix:
Gender:F
Credentials:ACUPUNCTURIEST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PARREMO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692
Mailing Address - Country:US
Mailing Address - Phone:949-581-8542
Mailing Address - Fax:
Practice Address - Street 1:502 HOLT AVENUE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768
Practice Address - Country:US
Practice Address - Phone:909-620-5699
Practice Address - Fax:909-620-5799
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9010171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0090100OtherMEDICAL