Provider Demographics
NPI:1245675271
Name:HASHEMI, SUZAN (LAC)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:HASHEMI
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 1:3 VERANO
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1827
Mailing Address - Country:US
Mailing Address - Phone:949-702-3344
Mailing Address - Fax:949-859-7808
Practice Address - Street 1:26740 TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2839
Practice Address - Country:US
Practice Address - Phone:949-588-9293
Practice Address - Fax:949-588-0409
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist