Provider Demographics
NPI:1871667311
Name:MAHGEREFTEH, NAZILA (DC)
Entity Type:Individual
Prefix:
First Name:NAZILA
Middle Name:
Last Name:MAHGEREFTEH
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 1:808 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5532
Mailing Address - Country:US
Mailing Address - Phone:310-406-1910
Mailing Address - Fax:310-406-1929
Practice Address - Street 1:808 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5532
Practice Address - Country:US
Practice Address - Phone:310-406-1910
Practice Address - Fax:310-406-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor