Provider Demographics
NPI:1598804114
Name:TABASSIAN, AZITA (DC)
Entity Type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:TABASSIAN
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 1:30055 AVENIDA ESPLENDIDA
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5420
Mailing Address - Country:US
Mailing Address - Phone:310-346-3207
Mailing Address - Fax:
Practice Address - Street 1:3400 LOMITA BLVD
Practice Address - Street 2:STE 502
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4988
Practice Address - Country:US
Practice Address - Phone:310-346-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2017-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0261520OtherBLUESHIELD
CADC0261520OtherBLUESHIELD
CAU74349Medicare UPIN