Healthcare Provider Details

I. General information

NPI: 1255474870
Provider Name (Legal Business Name): ARASH MOHRDAR GHAEMMAGHAMI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 12TH ST
RIVERSIDE CA
92501-3528
US

IV. Provider business mailing address

3816 12TH ST
RIVERSIDE CA
92501-3528
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-4529
  • Fax: 951-781-8198
Mailing address:
  • Phone: 951-781-4529
  • Fax: 951-781-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number21062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: