Provider Demographics
NPI:1730362179
Name:YAGHMAI, AZADEH (DC)
Entity type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:YAGHMAI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2563
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-2563
Mailing Address - Country:US
Mailing Address - Phone:888-649-0005
Mailing Address - Fax:888-401-9119
Practice Address - Street 1:3058 CLAIREMONT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6830
Practice Address - Country:US
Practice Address - Phone:888-649-0005
Practice Address - Fax:888-401-9119
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor