Provider Demographics
NPI:1699018903
Name:SORAYA WELLNESS & REHAB CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:SORAYA WELLNESS & REHAB CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:SORAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-625-7770
Mailing Address - Street 1:5757 WILSHIRE BLVD STE 490
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5811
Mailing Address - Country:US
Mailing Address - Phone:818-625-7770
Mailing Address - Fax:818-409-0181
Practice Address - Street 1:5757 WILSHIRE BLVD STE 490
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5811
Practice Address - Country:US
Practice Address - Phone:818-625-7770
Practice Address - Fax:818-409-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEU048A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty