Provider Demographics
NPI:1801184569
Name:BARSAMIAN, STEPHEN W
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:W
Last Name:BARSAMIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25458 CLAVELES CT
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-7616
Mailing Address - Country:US
Mailing Address - Phone:714-720-6285
Mailing Address - Fax:
Practice Address - Street 1:25458 CLAVELES CT
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-7616
Practice Address - Country:US
Practice Address - Phone:714-720-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6365225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6365Medicaid