Healthcare Provider Details

I. General information

NPI: 1578597605
Provider Name (Legal Business Name): FRED VAZIRI D.C., L.AC., Q.M.E
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20929 VENTURA BLVD 25
WOODLAND HILLS CA
91364-3353
US

IV. Provider business mailing address

20929 VENTURA BLVD 25
WOODLAND HILLS CA
91364-3353
US

V. Phone/Fax

Practice location:
  • Phone: 818-704-1188
  • Fax: 818-704-9588
Mailing address:
  • Phone: 818-704-1188
  • Fax: 818-704-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC21157
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: