Provider Demographics
NPI:1578695227
Name:DARDASHTI, ROBERT ELIA (DC,)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELIA
Last Name:DARDASHTI
Suffix:
Gender:M
Credentials:DC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24332 SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2913
Mailing Address - Country:US
Mailing Address - Phone:661-222-7575
Mailing Address - Fax:661-222-7872
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-789-5560
Practice Address - Fax:818-789-7025
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20870111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC20870OtherPROVIDER CA LICENSE
CADC20870OtherPROVIDER CA LICENSE