Provider Demographics
NPI:1780753798
Name:AZIMZADEH, MAHNAZ (DC)
Entity type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:
Last Name:AZIMZADEH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:AZIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:SUITE400
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1801
Mailing Address - Country:US
Mailing Address - Phone:818-501-5553
Mailing Address - Fax:818-501-2291
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:SUITE400
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1801
Practice Address - Country:US
Practice Address - Phone:818-501-5553
Practice Address - Fax:818-501-2291
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24277111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician