Provider Demographics
NPI:1487919304
Name:TABRIZI, GHAZALEH (DC)
Entity type:Individual
Prefix:DR
First Name:GHAZALEH
Middle Name:
Last Name:TABRIZI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:GYZEL
Other - Middle Name:
Other - Last Name:TABRIZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3140 RED HILL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3400
Mailing Address - Country:US
Mailing Address - Phone:714-957-1876
Mailing Address - Fax:
Practice Address - Street 1:3140 RED HILL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3400
Practice Address - Country:US
Practice Address - Phone:714-957-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor