Provider Demographics
NPI:1386815595
Name:BADALYAN, HERMINE
Entity Type:Individual
Prefix:
First Name:HERMINE
Middle Name:
Last Name:BADALYAN
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 1:2010 WILSHIRE BLVD
Mailing Address - Street 2:STE #502
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:818-726-8143
Mailing Address - Fax:818-559-7463
Practice Address - Street 1:2010 WILSHIRE BLVD
Practice Address - Street 2:STE #502
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:818-726-8143
Practice Address - Fax:818-559-7463
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies