Provider Demographics
NPI:1861635633
Name:BADIVIAN, KARINE REBECA (LAC)
Entity Type:Individual
Prefix:
First Name:KARINE
Middle Name:REBECA
Last Name:BADIVIAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3012
Mailing Address - Country:US
Mailing Address - Phone:818-563-3650
Mailing Address - Fax:818-563-3650
Practice Address - Street 1:949 BETHANY RD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3012
Practice Address - Country:US
Practice Address - Phone:818-563-3650
Practice Address - Fax:818-563-3650
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12930171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist