Provider Demographics
NPI:1689700973
Name:GARIFIANOVA, MARIAM (LAC)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:GARIFIANOVA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11524 15TH AVE NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6357
Mailing Address - Country:US
Mailing Address - Phone:206-361-0108
Mailing Address - Fax:206-361-0636
Practice Address - Street 1:11524 15TH AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6357
Practice Address - Country:US
Practice Address - Phone:206-361-0108
Practice Address - Fax:206-361-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000737171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073674388OtherGROUP NPI NUMBER
WA912097668OtherTIN # SOLE PROPRIETOR