Provider Demographics
NPI:1821418492
Name:BADIEFARD, SAEIDEH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SAEIDEH
Middle Name:
Last Name:BADIEFARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 RENEWAL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1195
Mailing Address - Country:US
Mailing Address - Phone:714-737-2517
Mailing Address - Fax:
Practice Address - Street 1:1125 E 17TH ST STE W237
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2205
Practice Address - Country:US
Practice Address - Phone:908-295-6187
Practice Address - Fax:714-852-3027
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist