Healthcare Provider Details

I. General information

NPI: 1548289176
Provider Name (Legal Business Name): YOAV NAGAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12626 RIVERSIDE DR STE 301
NORTH HOLLYWOOD CA
91607-3473
US

IV. Provider business mailing address

12626 RIVERSIDE DR STE 301
NORTH HOLLYWOOD CA
91607-3473
US

V. Phone/Fax

Practice location:
  • Phone: 818-760-0110
  • Fax: 818-760-0137
Mailing address:
  • Phone: 818-760-0110
  • Fax: 818-760-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC25477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: