Provider Demographics
NPI:1538302336
Name:FAYAZZADEH, HELENA (DC)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:FAYAZZADEH
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 1:1505 S BENTLEY AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3317
Mailing Address - Country:US
Mailing Address - Phone:310-748-7272
Mailing Address - Fax:
Practice Address - Street 1:6222 WILSHIRE BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5193
Practice Address - Country:US
Practice Address - Phone:323-525-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor