Provider Demographics
NPI:1407117195
Name:RAHIMZADEH MOGHADAM, ROYA (DC)
Entity Type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:RAHIMZADEH MOGHADAM
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:PO BOX 491694
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-8694
Mailing Address - Country:US
Mailing Address - Phone:310-802-9995
Mailing Address - Fax:818-780-1744
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:SUITE 356
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6308
Practice Address - Country:US
Practice Address - Phone:310-802-9995
Practice Address - Fax:818-780-1744
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor