Provider Demographics
NPI:1912283888
Name:MEHDIZADEGAN, LEYLA (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:LEYLA
Middle Name:
Last Name:MEHDIZADEGAN
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:DR
Other - First Name:LEYLA
Other - Middle Name:
Other - Last Name:MEHDIZADEGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC, LAC
Mailing Address - Street 1:1000 SAN GABRIEL BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-4394
Mailing Address - Country:US
Mailing Address - Phone:323-724-0019
Mailing Address - Fax:
Practice Address - Street 1:5232 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2002
Practice Address - Country:US
Practice Address - Phone:323-724-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14423171100000X
CA31507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist