Provider Demographics
NPI:1477123206
Name:MATAVOOSIAN, SINTIA (DC)
Entity type:Individual
Prefix:DR
First Name:SINTIA
Middle Name:
Last Name:MATAVOOSIAN
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 1:1012 E ACACIA AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4823
Mailing Address - Country:US
Mailing Address - Phone:818-455-9265
Mailing Address - Fax:
Practice Address - Street 1:625 FAIR OAKS AVE STE 119
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2684
Practice Address - Country:US
Practice Address - Phone:818-928-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor