Provider Demographics
NPI:1013289602
Name:MOEINI, SANAZ (DC)
Entity type:Individual
Prefix:
First Name:SANAZ
Middle Name:
Last Name:MOEINI
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 1:4546 EL CAMINO REAL STE B13
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1069
Mailing Address - Country:US
Mailing Address - Phone:408-893-4639
Mailing Address - Fax:
Practice Address - Street 1:4546 EL CAMINO REAL STE B13
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1069
Practice Address - Country:US
Practice Address - Phone:408-893-4639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor