Provider Demographics
NPI:1306003801
Name:BEHI, POURAN
Entity Type:Individual
Prefix:MRS
First Name:POURAN
Middle Name:
Last Name:BEHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 W BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6726
Mailing Address - Country:US
Mailing Address - Phone:559-304-9911
Mailing Address - Fax:
Practice Address - Street 1:487 W BIRCH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6726
Practice Address - Country:US
Practice Address - Phone:559-304-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA616951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse