Provider Demographics
NPI:1053487686
Name:MOKHBER-PELLICANI, GITI (DC)
Entity type:Individual
Prefix:DR
First Name:GITI
Middle Name:
Last Name:MOKHBER-PELLICANI
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 1:430 MARATHON DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0918
Mailing Address - Country:US
Mailing Address - Phone:408-378-2225
Mailing Address - Fax:408-370-6653
Practice Address - Street 1:430 MARATHON DR
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0918
Practice Address - Country:US
Practice Address - Phone:408-378-2225
Practice Address - Fax:408-370-6653
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0167550Medicare ID - Type Unspecified
DC16755Medicare UPIN