Provider Demographics
NPI:1932410156
Name:MOOSAD, DEEPAK MOHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:MOHAN
Last Name:MOOSAD
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 1:14538 LOS FUENTES RD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4352
Mailing Address - Country:US
Mailing Address - Phone:714-315-3033
Mailing Address - Fax:
Practice Address - Street 1:900 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1905
Practice Address - Country:US
Practice Address - Phone:714-637-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor