Provider Demographics
NPI:1427315332
Name:SOLTANPOUR, AFSANEH (DC)
Entity type:Individual
Prefix:
First Name:AFSANEH
Middle Name:
Last Name:SOLTANPOUR
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 1:4600 DUNMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3816
Mailing Address - Country:US
Mailing Address - Phone:818-400-4977
Mailing Address - Fax:
Practice Address - Street 1:17049 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4128
Practice Address - Country:US
Practice Address - Phone:818-907-2719
Practice Address - Fax:818-907-9376
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor