Provider Demographics
NPI:1720597925
Name:ANDRIANIFAHANANA, NIRINA-SOA M (MS,BCBA)
Entity Type:Individual
Prefix:
First Name:NIRINA-SOA
Middle Name:M
Last Name:ANDRIANIFAHANANA
Suffix:
Gender:F
Credentials:MS,BCBA
Other - Prefix:
Other - First Name:NIRINA
Other - Middle Name:
Other - Last Name:ANDRIANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,BCBA
Mailing Address - Street 1:145 S FAIRFAX AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2166
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:17203 PINTADO
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0291
Practice Address - Country:US
Practice Address - Phone:571-490-1813
Practice Address - Fax:903-200-1505
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst