Provider Demographics
NPI:1023252772
Name:MIGDALI, ILAN (LAC)
Entity type:Individual
Prefix:
First Name:ILAN
Middle Name:
Last Name:MIGDALI
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 1:2045 ROYAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4666
Mailing Address - Country:US
Mailing Address - Phone:805-527-2754
Mailing Address - Fax:805-527-8889
Practice Address - Street 1:2045 ROYAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4666
Practice Address - Country:US
Practice Address - Phone:805-527-2754
Practice Address - Fax:805-527-8889
Is Sole Proprietor?:No
Enumeration Date:2009-04-25
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3422171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist