Healthcare Provider Details

I. General information

NPI: 1922593573
Provider Name (Legal Business Name): LEE & MAHMOUDI CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29050 S WESTERN AVE STE 152
RANCHO PALOS VERDES CA
90275-0812
US

IV. Provider business mailing address

29050 S WESTERN AVE STE 152
RANCHO PALOS VERDES CA
90275-0812
US

V. Phone/Fax

Practice location:
  • Phone: 310-519-8877
  • Fax: 310-519-8290
Mailing address:
  • Phone: 310-519-8877
  • Fax: 310-519-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: GHAZALEH MONICA MAHMOUDI
Title or Position: PARTNER/OWNER
Credential: DC, LAC
Phone: 310-519-8877