Provider Demographics
NPI:1891377958
Name:BADALYAN, NAIRA (OWNER)
Entity Type:Individual
Prefix:MS
First Name:NAIRA
Middle Name:
Last Name:BADALYAN
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S BELMONT ST APT E
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1868
Mailing Address - Country:US
Mailing Address - Phone:818-392-0843
Mailing Address - Fax:
Practice Address - Street 1:510 S BELMONT ST APT E
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1868
Practice Address - Country:US
Practice Address - Phone:818-392-0843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197609819374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide