Provider Demographics
NPI:1003206129
Name:NAGOULAT, MAJED ANDRE (DC)
Entity Type:Individual
Prefix:
First Name:MAJED
Middle Name:ANDRE
Last Name:NAGOULAT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-1614
Mailing Address - Country:US
Mailing Address - Phone:714-717-9596
Mailing Address - Fax:
Practice Address - Street 1:5790 MAGNOLIA AVE STE 104
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1874
Practice Address - Country:US
Practice Address - Phone:951-888-1538
Practice Address - Fax:951-848-9155
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33159111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician