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General NPI Number Information
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NPI Number | 1336183110
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Entity Type | Individual
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Provider Name | ALFRED A DERAKHSHESH D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 09/17/2007
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Provider Practice Location Address
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Address Line | 1016 S ROBERTSON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-1505
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Country | US
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Telephone | 310-652-9283
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Fax | 310-652-9292
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Provider Business Mailing Address
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Address Line | 1470 REXFORD DR #207
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City | LOS ANGELES
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State | CA
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Zip | 90035-3145
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Country | US
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Telephone | 310-722-0800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DC24112
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License Number State | CA
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