Provider Demographics
NPI:1063797744
Name:ROUHANI, SANAZ
Entity type:Individual
Prefix:
First Name:SANAZ
Middle Name:
Last Name:ROUHANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 IRVINE BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3801
Mailing Address - Country:US
Mailing Address - Phone:714-544-1600
Mailing Address - Fax:
Practice Address - Street 1:1442 IRVINE BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3801
Practice Address - Country:US
Practice Address - Phone:714-544-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor