Provider Demographics
NPI:1790885721
Name:NASSERAZARI, LINDA (LAC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:NASSERAZARI
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 1:7245 HILLSIDE AVE
Mailing Address - Street 2:#311
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:323-851-1730
Mailing Address - Fax:
Practice Address - Street 1:14623 HAWTHORNE BLVD
Practice Address - Street 2:#402
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:310-263-0088
Practice Address - Fax:310-263-1188
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10954171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist