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General NPI Number Information
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NPI Number | 1043540115
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Entity Type | Organization
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Legal Business Name | HEALTH CLINIC OF SOUTHERN CALIFORNIA INC
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 17337 VENTURA BLVD SUITE 203
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City | ENCINO
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State | CA
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Zip | 91316-3903
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Country | US
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Telephone | 818-990-5321
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Fax | 818-990-6953
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Provider Business Mailing Address
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Address Line | 17337 VENTURA BOULEVARD SUITE 203
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City | ENCINO
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State | CA
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Zip | 91316
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Country | US
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Telephone | 818-990-5321
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Fax | 818-990-6953
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Authorized Official
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Title or Position | OWNER
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Name | DR. NEDA MEHRABANI LADJEVARDI
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Credential | D.C, LAC
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Telephone | 818-990-5321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC25902
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License Number State | CA
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