Provider Demographics
NPI:1932212966
Name:MAHGEREFTEH, OMID (DC)
Entity Type:Individual
Prefix:
First Name:OMID
Middle Name:
Last Name:MAHGEREFTEH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 E AVENUE S
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-6196
Mailing Address - Country:US
Mailing Address - Phone:661-267-6876
Mailing Address - Fax:661-267-0438
Practice Address - Street 1:1220 E AVENUE S
Practice Address - Street 2:SUITE C
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-6196
Practice Address - Country:US
Practice Address - Phone:661-267-6876
Practice Address - Fax:661-267-0438
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor