Provider Demographics
NPI:1679788236
Name:SHAMAEIZADEH, MAHBOUBEH (ACUPUNCTURE)
Entity type:Individual
Prefix:
First Name:MAHBOUBEH
Middle Name:
Last Name:SHAMAEIZADEH
Suffix:
Gender:F
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19474 RINALDI ST
Mailing Address - Street 2:NOSUIT
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1646
Mailing Address - Country:US
Mailing Address - Phone:818-831-0100
Mailing Address - Fax:818-831-0135
Practice Address - Street 1:19474RINALDIST
Practice Address - Street 2:NOSUITE
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326
Practice Address - Country:US
Practice Address - Phone:818-831-0100
Practice Address - Fax:818-831-0135
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist