Healthcare Provider Details

I. General information

NPI: 1619487220
Provider Name (Legal Business Name): SAM VAZIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2537 PACIFIC COAST HWY STE B
TORRANCE CA
90505-7064
US

IV. Provider business mailing address

28827 LEAH CIR
RANCHO PALOS VERDES CA
90275-4767
US

V. Phone/Fax

Practice location:
  • Phone: 424-235-1562
  • Fax: 424-235-1561
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: