Provider Demographics
NPI:1225118904
Name:MOAREFI, REZA MAHMOUD (DC)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:MAHMOUD
Last Name:MOAREFI
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 1:14500 ROSCOE BLVD
Mailing Address - Street 2:#201
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4190
Mailing Address - Country:US
Mailing Address - Phone:818-891-4000
Mailing Address - Fax:818-891-4003
Practice Address - Street 1:14500 ROSCOE BLVD
Practice Address - Street 2:#201
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:818-891-4000
Practice Address - Fax:818-891-4003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor