Provider Demographics
NPI:1265620298
Name:SAMOUHA, BEHROOZ (DC)
Entity type:Individual
Prefix:DR
First Name:BEHROOZ
Middle Name:
Last Name:SAMOUHA
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 1:17750 SHERMAN WAY
Mailing Address - Street 2:100
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3380
Mailing Address - Country:US
Mailing Address - Phone:818-705-7200
Mailing Address - Fax:818-343-0805
Practice Address - Street 1:101 N LA BREA AVE
Practice Address - Street 2:101
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1769
Practice Address - Country:US
Practice Address - Phone:310-674-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor