Provider Demographics
NPI:1124593025
Name:FARIDIAN, ANDREW BEHRANG
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BEHRANG
Last Name:FARIDIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3506
Mailing Address - Country:US
Mailing Address - Phone:310-927-4912
Mailing Address - Fax:
Practice Address - Street 1:308 S OAKHURST DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3506
Practice Address - Country:US
Practice Address - Phone:310-927-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18976225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics