Provider Demographics
NPI:1164561239
Name:FARBENBLOOM, YANIV (DC)
Entity Type:Individual
Prefix:
First Name:YANIV
Middle Name:
Last Name:FARBENBLOOM
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 1:16133 VENTURA BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2406
Mailing Address - Country:US
Mailing Address - Phone:818-377-7444
Mailing Address - Fax:415-634-1356
Practice Address - Street 1:16133 VENTURA BLVD STE 700
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2406
Practice Address - Country:US
Practice Address - Phone:818-377-7444
Practice Address - Fax:415-634-1356
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25863111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician