Provider Demographics
NPI:1083149819
Name:NAZER, ELLIE
Entity Type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:NAZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELAHEHNAZER
Other - Middle Name:
Other - Last Name:NAZERZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:730 FLAGSTONE CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2206
Mailing Address - Country:US
Mailing Address - Phone:760-805-9974
Mailing Address - Fax:
Practice Address - Street 1:710 S BROOKHURST ST STE D
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4321
Practice Address - Country:US
Practice Address - Phone:714-533-2002
Practice Address - Fax:714-533-2902
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33853111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor