Provider Demographics
NPI:1912198078
Name:MAHBOUBIAN, HAMID (LAC)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:MAHBOUBIAN
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 1:31751 VIA PERDIZ
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-4179
Mailing Address - Country:US
Mailing Address - Phone:310-593-1885
Mailing Address - Fax:310-395-3937
Practice Address - Street 1:31751 VIA PERDIZ
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-4179
Practice Address - Country:US
Practice Address - Phone:661-945-1899
Practice Address - Fax:661-940-4539
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3408171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist