Provider Demographics
NPI:1861798381
Name:TAGHDIRI, FARIDEH (LAC)
Entity type:Individual
Prefix:
First Name:FARIDEH
Middle Name:
Last Name:TAGHDIRI
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 1:19626 VENTURA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2944
Mailing Address - Country:US
Mailing Address - Phone:818-653-4234
Mailing Address - Fax:818-831-5253
Practice Address - Street 1:19626 VENTURA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2944
Practice Address - Country:US
Practice Address - Phone:818-653-4234
Practice Address - Fax:818-831-5253
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13843171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist