Provider Demographics
NPI:1659543072
Name:SEDARATI-OLIAIE, BAHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHAR
Middle Name:
Last Name:SEDARATI-OLIAIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24331 EL TORO RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2752
Mailing Address - Country:US
Mailing Address - Phone:310-980-1781
Mailing Address - Fax:949-600-8822
Practice Address - Street 1:24331 EL TORO RD
Practice Address - Street 2:SUITE 360
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2752
Practice Address - Country:US
Practice Address - Phone:310-980-1781
Practice Address - Fax:949-600-8822
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist