Provider Demographics
NPI:1649422577
Name:ARASTOUZADEH, JACKLIN (LAC)
Entity type:Individual
Prefix:DR
First Name:JACKLIN
Middle Name:
Last Name:ARASTOUZADEH
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 1:9025 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1831
Mailing Address - Country:US
Mailing Address - Phone:310-777-0388
Mailing Address - Fax:310-777-0429
Practice Address - Street 1:9025 WILSHIRE BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1831
Practice Address - Country:US
Practice Address - Phone:310-777-0388
Practice Address - Fax:310-777-0429
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4526171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist