Provider Demographics
NPI:1043540115
Name:HEALTH CLINIC OF SOUTHERN CALIFORNIA INC
Entity Type:Organization
Organization Name:HEALTH CLINIC OF SOUTHERN CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:MEHRABANI
Authorized Official - Last Name:LADJEVARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:818-990-5321
Mailing Address - Street 1:17337 VENTURA BOULEVARD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-990-5321
Mailing Address - Fax:818-990-6953
Practice Address - Street 1:17337 VENTURA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3903
Practice Address - Country:US
Practice Address - Phone:818-990-5321
Practice Address - Fax:818-990-6953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX IDENTIFICATION NUMBER