Healthcare Provider Details

I. General information

NPI: 1013135656
Provider Name (Legal Business Name): RASOUL POOYANDEH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RASOUL POOYANDEH CHIROPRACTOR

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W. HOLT AVE.
POMONA CA
91768
US

IV. Provider business mailing address

502 W HOLT AVE
POMONA CA
91768-3604
US

V. Phone/Fax

Practice location:
  • Phone: 909-620-5699
  • Fax: 909-620-5799
Mailing address:
  • Phone: 909-620-5699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: