Provider Demographics
NPI:1235892613
Name:TARAMESHLOOPOOR, SEPIDEH
Entity Type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:TARAMESHLOOPOOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W LEXINGTON DR # A405
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3118
Mailing Address - Country:US
Mailing Address - Phone:818-644-5012
Mailing Address - Fax:
Practice Address - Street 1:7951 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1848
Practice Address - Country:US
Practice Address - Phone:714-994-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor