Provider Demographics
NPI:1235234048
Name:RAZIPOUR, MITRA (DC)
Entity Type:Individual
Prefix:DR
First Name:MITRA
Middle Name:
Last Name:RAZIPOUR
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 1:20969 VENTURA BLVD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2305
Mailing Address - Country:US
Mailing Address - Phone:818-992-5252
Mailing Address - Fax:818-992-5292
Practice Address - Street 1:20969 VENTURA BLVD
Practice Address - Street 2:SUITE 23
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2305
Practice Address - Country:US
Practice Address - Phone:818-992-5252
Practice Address - Fax:818-992-5292
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29373Medicare ID - Type Unspecified