Provider Demographics
NPI:1841441706
Name:BARAHIMI, MANDANA (MD)
Entity type:Individual
Prefix:DR
First Name:MANDANA
Middle Name:
Last Name:BARAHIMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4187
Mailing Address - Country:US
Mailing Address - Phone:818-727-1515
Mailing Address - Fax:818-727-7997
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4187
Practice Address - Country:US
Practice Address - Phone:818-727-1515
Practice Address - Fax:818-727-7997
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No282N00000XHospitalsGeneral Acute Care Hospital