Provider Demographics
NPI:1841007010
Name:DARVISH, ERIC (LAC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:DARVISH
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 1:2117 1/2 S BEVERLY GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6029
Mailing Address - Country:US
Mailing Address - Phone:323-840-6940
Mailing Address - Fax:
Practice Address - Street 1:1280 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4423
Practice Address - Country:US
Practice Address - Phone:424-272-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist