Provider Demographics
NPI:1831466192
Name:FOULADIAN, GHAZALEH
Entity Type:Individual
Prefix:
First Name:GHAZALEH
Middle Name:
Last Name:FOULADIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 S BENTLEY AVE
Mailing Address - Street 2:#203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5652
Mailing Address - Country:US
Mailing Address - Phone:310-699-7790
Mailing Address - Fax:
Practice Address - Street 1:2051 S BENTLEY AVE
Practice Address - Street 2:#203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5652
Practice Address - Country:US
Practice Address - Phone:310-699-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24654124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist