Provider Demographics
NPI:1255132411
Name:GHORBANI, PEGGY (LAC)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:GHORBANI
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BEN HOWELL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5422
Mailing Address - Country:US
Mailing Address - Phone:512-294-6895
Mailing Address - Fax:
Practice Address - Street 1:720 W 34TH ST STE 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1215
Practice Address - Country:US
Practice Address - Phone:512-294-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00802171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist