Provider Demographics
NPI:1861026353
Name:BAHMANI, NICKITA
Entity Type:Individual
Prefix:
First Name:NICKITA
Middle Name:
Last Name:BAHMANI
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 1:26355 W PLATA LN
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2616
Mailing Address - Country:US
Mailing Address - Phone:818-337-8096
Mailing Address - Fax:
Practice Address - Street 1:26355 W PLATA LN
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-2616
Practice Address - Country:US
Practice Address - Phone:818-337-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32164225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist