Provider Demographics
NPI:1205179033
Name:BADALIAN, VIGOOSH (RD)
Entity Type:Individual
Prefix:
First Name:VIGOOSH
Middle Name:
Last Name:BADALIAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 CHEVY OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1821
Mailing Address - Country:US
Mailing Address - Phone:818-486-1364
Mailing Address - Fax:
Practice Address - Street 1:4170 VERDUGO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3821
Practice Address - Country:US
Practice Address - Phone:323-257-5115
Practice Address - Fax:323-256-2695
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered