Provider Demographics
NPI:1619355096
Name:PARIVAR, ELIKA
Entity Type:Individual
Prefix:
First Name:ELIKA
Middle Name:
Last Name:PARIVAR
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 1:385 S LOS ROBLES AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3221
Mailing Address - Country:US
Mailing Address - Phone:626-437-1779
Mailing Address - Fax:
Practice Address - Street 1:385 S LOS ROBLES AVE APT 7
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3221
Practice Address - Country:US
Practice Address - Phone:626-437-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer