Provider Demographics
NPI:1083719132
Name:DEHGHAN-ABNAVI, FARANAK (DC)
Entity Type:Individual
Prefix:DR
First Name:FARANAK
Middle Name:
Last Name:DEHGHAN-ABNAVI
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 1:8923 DE SOTO AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-1966
Mailing Address - Country:US
Mailing Address - Phone:818-576-0901
Mailing Address - Fax:818-576-0902
Practice Address - Street 1:8923 DE SOTO AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-1966
Practice Address - Country:US
Practice Address - Phone:818-576-0901
Practice Address - Fax:818-576-0902
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24882Medicare ID - Type Unspecified