Provider Demographics
NPI:1952421281
Name:MOGHARABI, FARDAD (DC)
Entity type:Individual
Prefix:DR
First Name:FARDAD
Middle Name:
Last Name:MOGHARABI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 E VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1536
Mailing Address - Country:US
Mailing Address - Phone:562-354-6900
Mailing Address - Fax:562-354-6902
Practice Address - Street 1:4426 E VILLAGE RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1536
Practice Address - Country:US
Practice Address - Phone:562-354-6900
Practice Address - Fax:562-354-6900
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23324111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23324Medicare UPIN
CADC23324Medicare UPIN