Provider Demographics
NPI:1750564035
Name:DERAKHSHANFAR, FARZANEH (DC)
Entity type:Individual
Prefix:DR
First Name:FARZANEH
Middle Name:
Last Name:DERAKHSHANFAR
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:PO BOX 570696
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-0696
Mailing Address - Country:US
Mailing Address - Phone:818-731-2627
Mailing Address - Fax:323-852-1722
Practice Address - Street 1:6399 WILSHIRE BLVD STE 315
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5706
Practice Address - Country:US
Practice Address - Phone:323-236-8467
Practice Address - Fax:323-852-1722
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA25005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25005Medicare PIN