Provider Demographics
NPI:1295166593
Name:MIZRAHI, AQUI (LAC)
Entity type:Individual
Prefix:
First Name:AQUI
Middle Name:
Last Name:MIZRAHI
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 1:3295 34TH ST
Mailing Address - Street 2:#67
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1976
Mailing Address - Country:US
Mailing Address - Phone:303-828-6759
Mailing Address - Fax:
Practice Address - Street 1:3400 TABLE MESA DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5869
Practice Address - Country:US
Practice Address - Phone:303-499-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1957171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist