Provider Demographics
NPI:1609112697
Name:BAHARI, CAROL R (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:R
Last Name:BAHARI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 ARROYO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3002
Mailing Address - Country:US
Mailing Address - Phone:714-269-5990
Mailing Address - Fax:
Practice Address - Street 1:11611 ARROYO AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3002
Practice Address - Country:US
Practice Address - Phone:714-269-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389901163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics