Provider Demographics
NPI:1750910535
Name:SHAHRIARI, LALEH
Entity type:Individual
Prefix:
First Name:LALEH
Middle Name:
Last Name:SHAHRIARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CUPERTINO CIR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-8076
Mailing Address - Country:US
Mailing Address - Phone:714-227-5496
Mailing Address - Fax:
Practice Address - Street 1:14390 CIVIC DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9709
Practice Address - Country:US
Practice Address - Phone:714-227-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist