Provider Demographics
NPI:1518548692
Name:AHDOOT, ADRIANNE
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:
Last Name:AHDOOT
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 1:18375 VENTURA BLVD STE 852
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4218
Mailing Address - Country:US
Mailing Address - Phone:818-577-0650
Mailing Address - Fax:
Practice Address - Street 1:18375 VENTURA BLVD STE 852
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4218
Practice Address - Country:US
Practice Address - Phone:818-577-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant