Provider Demographics
NPI:1225113293
Name:BARADAR, MAHNAZ (NP)
Entity Type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:
Last Name:BARADAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 W LA VETA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3930
Mailing Address - Country:US
Mailing Address - Phone:714-289-6565
Mailing Address - Fax:
Practice Address - Street 1:845 W LA VETA AVE STE 105
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3930
Practice Address - Country:US
Practice Address - Phone:714-289-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12943363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ05219Medicare UPIN