Provider Demographics
NPI:1316345630
Name:ASHTIANI, MAYMANAT SHADI (DC)
Entity type:Individual
Prefix:DR
First Name:MAYMANAT
Middle Name:SHADI
Last Name:ASHTIANI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22622 LAMBERT ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1609
Mailing Address - Country:US
Mailing Address - Phone:949-699-2796
Mailing Address - Fax:949-699-2796
Practice Address - Street 1:22622 LAMBERT ST
Practice Address - Street 2:SUITE 308
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1609
Practice Address - Country:US
Practice Address - Phone:949-699-2796
Practice Address - Fax:949-699-2796
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor