Provider Demographics
NPI:1962653808
Name:SHOKOUH, ROKSANA (DC)
Entity Type:Individual
Prefix:DR
First Name:ROKSANA
Middle Name:
Last Name:SHOKOUH
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 1:1530 N POINSETTIA PL APT 236
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7915
Mailing Address - Country:US
Mailing Address - Phone:323-233-0504
Mailing Address - Fax:323-233-0593
Practice Address - Street 1:231 W VERNON AVE STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2778
Practice Address - Country:US
Practice Address - Phone:323-233-0504
Practice Address - Fax:323-233-0593
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23983111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner