Provider Demographics
NPI:1770719056
Name:MAHROUYAN, NITA (DC)
Entity type:Individual
Prefix:DR
First Name:NITA
Middle Name:
Last Name:MAHROUYAN
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 1:1353 N FULLER AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4997
Mailing Address - Country:US
Mailing Address - Phone:323-326-4881
Mailing Address - Fax:
Practice Address - Street 1:1353 N FULLER AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4997
Practice Address - Country:US
Practice Address - Phone:323-326-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor