Provider Demographics
NPI:1255308904
Name:BEHRAVAN, HOOMAN DARIEN (DO)
Entity Type:Individual
Prefix:DR
First Name:HOOMAN
Middle Name:DARIEN
Last Name:BEHRAVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13690 E 14TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2582
Mailing Address - Country:US
Mailing Address - Phone:510-614-9200
Mailing Address - Fax:510-614-9203
Practice Address - Street 1:13690 E 14TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2582
Practice Address - Country:US
Practice Address - Phone:510-614-9200
Practice Address - Fax:510-614-9203
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8004207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A80041Medicare ID - Type UnspecifiedPPIN
CAH81300Medicare UPIN