Provider Demographics
NPI:1710614599
Name:BARANDIARAN, ASHLEY (DACM LAC)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:BARANDIARAN
Suffix:
Gender:F
Credentials:DACM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 CLOVE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1709
Mailing Address - Country:US
Mailing Address - Phone:619-964-7564
Mailing Address - Fax:
Practice Address - Street 1:1834 CLOVE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-1709
Practice Address - Country:US
Practice Address - Phone:619-964-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18666171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty