Provider Demographics
NPI:1568212207
Name:NADERI, AFSOUN (DC)
Entity Type:Individual
Prefix:DR
First Name:AFSOUN
Middle Name:
Last Name:NADERI
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 1:10 VIA AMBRA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1610
Mailing Address - Country:US
Mailing Address - Phone:714-501-2724
Mailing Address - Fax:
Practice Address - Street 1:6850 BROCKTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3814
Practice Address - Country:US
Practice Address - Phone:951-444-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor