Provider Demographics
NPI:1619362506
Name:PARVINJAH, SHAHROUZ (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAHROUZ
Middle Name:
Last Name:PARVINJAH
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 1:17961 MARTHA ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1050
Mailing Address - Country:US
Mailing Address - Phone:949-748-0941
Mailing Address - Fax:
Practice Address - Street 1:16200 VENTURA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4633
Practice Address - Country:US
Practice Address - Phone:818-986-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor