Healthcare Provider Details

I. General information

NPI: 1972510162
Provider Name (Legal Business Name): NAZANINE BARCOHANA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WILSHIRE BLVD SUITE 559
LOS ANGELES CA
90036-5810
US

IV. Provider business mailing address

5757 WILSHIRE BLVD SUITE 559
LOS ANGELES CA
90036-5810
US

V. Phone/Fax

Practice location:
  • Phone: 323-934-9588
  • Fax: 323-934-9618
Mailing address:
  • Phone: 323-934-9588
  • Fax: 323-934-9618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number45353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: