Provider Demographics
NPI:1922182757
Name:HASSID-JEBELI, MEHRNOUSH (DC)
Entity type:Individual
Prefix:MRS
First Name:MEHRNOUSH
Middle Name:
Last Name:HASSID-JEBELI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 S BEVERLY DR
Mailing Address - Street 2:SUITE #410
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1153
Mailing Address - Country:US
Mailing Address - Phone:310-277-1022
Mailing Address - Fax:
Practice Address - Street 1:1180 S BEVERLY DR
Practice Address - Street 2:SUITE #410
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1153
Practice Address - Country:US
Practice Address - Phone:310-277-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23270Medicare PIN