Provider Demographics
NPI:1306997556
Name:AGHLARA, AMIR (DC)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:AGHLARA
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 1:1800 N BRISTOL ST
Mailing Address - Street 2:#C614
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3336
Mailing Address - Country:US
Mailing Address - Phone:714-543-1414
Mailing Address - Fax:
Practice Address - Street 1:1800 N BRISTOL ST
Practice Address - Street 2:#C614
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3336
Practice Address - Country:US
Practice Address - Phone:714-543-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor