Provider Demographics
NPI:1457411407
Name:HASTANAN, NIPA (DC)
Entity Type:Individual
Prefix:DR
First Name:NIPA
Middle Name:
Last Name:HASTANAN
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 1:316 N LUCERNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3016
Mailing Address - Country:US
Mailing Address - Phone:323-461-9607
Mailing Address - Fax:
Practice Address - Street 1:7301 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1782
Practice Address - Country:US
Practice Address - Phone:818-786-7300
Practice Address - Fax:818-786-7319
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor