Healthcare Provider Details

I. General information

NPI: 1578447223
Provider Name (Legal Business Name): BABAK BARAVARIAN, DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8436 W 3RD ST STE 800
LOS ANGELES CA
90048-4100
US

IV. Provider business mailing address

151 ESPARTA WAY
SANTA MONICA CA
90402-2138
US

V. Phone/Fax

Practice location:
  • Phone: 310-435-9279
  • Fax:
Mailing address:
  • Phone: 310-435-9279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BABAK BARAVARIAN
Title or Position: OWNER
Credential: DPM
Phone: 310-435-9279