Provider Demographics
NPI:1275676215
Name:GIDANIAN, FARNOUSH COHANIM (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:FARNOUSH
Middle Name:COHANIM
Last Name:GIDANIAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MS
Other - First Name:FRANOUSH
Other - Middle Name:
Other - Last Name:COHANIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2755 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2040
Mailing Address - Country:US
Mailing Address - Phone:949-533-3557
Mailing Address - Fax:949-497-3986
Practice Address - Street 1:2755 PARK AVE
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2040
Practice Address - Country:US
Practice Address - Phone:949-533-3557
Practice Address - Fax:949-497-3986
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered