Healthcare Provider Details

I. General information

NPI: 1912283888
Provider Name (Legal Business Name): LEYLA MEHDIZADEGAN D.C., L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEYLA MEHDIZADEGAN D.C., L.AC

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5232 E BEVERLY BLVD
LOS ANGELES CA
90022-2002
US

IV. Provider business mailing address

1000 SAN GABRIEL BLVD STE 200
ROSEMEAD CA
91770-4394
US

V. Phone/Fax

Practice location:
  • Phone: 323-724-6911
  • Fax:
Mailing address:
  • Phone: 323-724-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14423
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number31507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: