Provider Demographics
NPI:1154439826
Name:TAFRESHI, MANSOUR (DC)
Entity Type:Individual
Prefix:
First Name:MANSOUR
Middle Name:
Last Name:TAFRESHI
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 1:26322 CANNES CIR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5215
Mailing Address - Country:US
Mailing Address - Phone:949-582-7700
Mailing Address - Fax:949-588-1380
Practice Address - Street 1:23361 EL TORO RD STE 103
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4810
Practice Address - Country:US
Practice Address - Phone:949-588-1158
Practice Address - Fax:949-588-1380
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU59039Medicare PIN