Provider Demographics
NPI:1821178633
Name:NARAYANAN, BHAVADHARINI (MD)
Entity Type:Individual
Prefix:
First Name:BHAVADHARINI
Middle Name:
Last Name:NARAYANAN
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 1:101 E BEVERLY BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4316
Mailing Address - Country:US
Mailing Address - Phone:323-888-8646
Mailing Address - Fax:323-888-1553
Practice Address - Street 1:101 E BEVERLY BLVD STE 306
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4316
Practice Address - Country:US
Practice Address - Phone:323-888-8646
Practice Address - Fax:323-888-1553
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68048208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A680480Medicaid