Healthcare Provider Details

I. General information

NPI: 1265629752
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA CORF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18531 ROSCOE BLVD. 215
NORTHRIDGE CA
91324
US

IV. Provider business mailing address

11024 BALBOA BLVD. 504
GRANADA HILLS CA
91344
US

V. Phone/Fax

Practice location:
  • Phone: 818-700-0478
  • Fax: 818-975-9995
Mailing address:
  • Phone: 818-700-0478
  • Fax: 818-700-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 27178
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27178
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28631
License Number StateCA

VIII. Authorized Official

Name: ARA TEPELEKIAN
Title or Position: PRESIDENT
Credential: D.C
Phone: 818-700-0478