Provider Demographics
NPI:1104218916
Name:ROSTAMI, SHERRY (DC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:ROSTAMI
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 1:4025 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-4222
Mailing Address - Country:US
Mailing Address - Phone:626-960-7222
Mailing Address - Fax:626-960-2277
Practice Address - Street 1:4025 MAINE AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-4222
Practice Address - Country:US
Practice Address - Phone:626-960-7222
Practice Address - Fax:626-960-2277
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor