Provider Demographics
NPI:1881090843
Name:MIRAMADI, MANDANA (DC)
Entity type:Individual
Prefix:DR
First Name:MANDANA
Middle Name:
Last Name:MIRAMADI
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:PO BOX 17633
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-7633
Mailing Address - Country:US
Mailing Address - Phone:714-602-7479
Mailing Address - Fax:714-602-7408
Practice Address - Street 1:1122 E LINCOLN AVE STE B200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1918
Practice Address - Country:US
Practice Address - Phone:714-602-7479
Practice Address - Fax:714-602-7408
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 33004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor