Healthcare Provider Details

I. General information

NPI: 1124593025
Provider Name (Legal Business Name): ANDREW BEHRANG FARIDIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2018
Last Update Date: 10/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S OAKHURST DR
BEVERLY HILLS CA
90212-3506
US

IV. Provider business mailing address

308 S OAKHURST DR
BEVERLY HILLS CA
90212-3506
US

V. Phone/Fax

Practice location:
  • Phone: 310-927-4912
  • Fax:
Mailing address:
  • Phone: 310-927-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: