Provider Demographics
NPI:1851597298
Name:ASSADI, MARYAM (DC)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:ASSADI
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 1:23412 MOULTON PKWY
Mailing Address - Street 2:STE. 120
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1732
Mailing Address - Country:US
Mailing Address - Phone:949-829-6927
Mailing Address - Fax:949-829-0221
Practice Address - Street 1:23412 MOULTON PKWY
Practice Address - Street 2:STE. 120
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1732
Practice Address - Country:US
Practice Address - Phone:949-829-6927
Practice Address - Fax:949-829-0221
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-28206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor