Provider Demographics
NPI:1578607529
Name:YASSINI, FARNOUSH A (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:FARNOUSH
Middle Name:A
Last Name:YASSINI
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47000 WARM SPRINGS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7467
Mailing Address - Country:US
Mailing Address - Phone:510-651-6202
Mailing Address - Fax:510-651-6203
Practice Address - Street 1:47000 WARM SPRINGS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7467
Practice Address - Country:US
Practice Address - Phone:510-651-6202
Practice Address - Fax:510-651-6203
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29158111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29158Medicare ID - Type UnspecifiedCHIROPRACTOR