Provider Demographics
NPI:1376576389
Name:MOHEBBI, MOHAMMAD FARHAD (CHIROPRACTIC)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:FARHAD
Last Name:MOHEBBI
Suffix:
Gender:M
Credentials:CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23412 MOULTON PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1732
Mailing Address - Country:US
Mailing Address - Phone:949-829-6927
Mailing Address - Fax:949-829-0221
Practice Address - Street 1:23412 MOULTON PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1732
Practice Address - Country:US
Practice Address - Phone:949-829-6927
Practice Address - Fax:949-829-0221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0208760OtherDC
CADC20876 AMedicare ID - Type UnspecifiedDC