Healthcare Provider Details

I. General information

NPI: 1295205235
Provider Name (Legal Business Name): BAHAR YOUDAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 S CENTINELA AVE
CULVER CITY CA
90230-6301
US

IV. Provider business mailing address

102 N SWEETZER AVE APT 104
LOS ANGELES CA
90048-6614
US

V. Phone/Fax

Practice location:
  • Phone: 310-337-7115
  • Fax:
Mailing address:
  • Phone: 818-388-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: