Provider Demographics
NPI:1407907983
Name:MOROVATI, ANTHONY BEN
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BEN
Last Name:MOROVATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:BEN
Other - Last Name:MOROVATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1111 N BRAND BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3023
Mailing Address - Country:US
Mailing Address - Phone:818-500-8484
Mailing Address - Fax:818-500-8484
Practice Address - Street 1:1111 N BRAND BLVD STE B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3023
Practice Address - Country:US
Practice Address - Phone:818-500-8484
Practice Address - Fax:818-500-8484
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor