Provider Demographics
NPI:1780807040
Name:BAHARIANCE, ANDROOHI (LAC)
Entity type:Individual
Prefix:MS
First Name:ANDROOHI
Middle Name:
Last Name:BAHARIANCE
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 1:540 N CENTRAL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1916
Mailing Address - Country:US
Mailing Address - Phone:818-246-5100
Mailing Address - Fax:818-246-5200
Practice Address - Street 1:540 N CENTRAL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1916
Practice Address - Country:US
Practice Address - Phone:818-246-5100
Practice Address - Fax:818-246-5200
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist