Provider Demographics
NPI:1689838989
Name:JAVAHERIAN, MOHAMMAD (LAC)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:JAVAHERIAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 SILVERBUSH CREEK ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5782
Mailing Address - Country:US
Mailing Address - Phone:858-922-5756
Mailing Address - Fax:
Practice Address - Street 1:1011 CAMINO DEL MAR
Practice Address - Street 2:240
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2640
Practice Address - Country:US
Practice Address - Phone:858-922-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10748171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist