Healthcare Provider Details

I. General information

NPI: 1225575160
Provider Name (Legal Business Name): MEHRBANOO KHEZRIZARDOSHTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 TORRANCE BLVD SUITE 201
TORRANCE CA
90503-4812
US

IV. Provider business mailing address

PO BOX 5273
PALOS VERDES PENINSULA CA
90274-9678
US

V. Phone/Fax

Practice location:
  • Phone: 424-360-0066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: