Healthcare Provider Details

I. General information

NPI: 1962653808
Provider Name (Legal Business Name): ROKSANA SHOKOUH DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W VERNON AVE STE 102
LOS ANGELES CA
90037-2778
US

IV. Provider business mailing address

1530 N POINSETTIA PL APT 236
LOS ANGELES CA
90046-7915
US

V. Phone/Fax

Practice location:
  • Phone: 323-233-0504
  • Fax: 323-233-0593
Mailing address:
  • Phone: 323-233-0504
  • Fax: 323-233-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC 23983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: