Healthcare Provider Details

I. General information

NPI: 1487826871
Provider Name (Legal Business Name): ANI BARONI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12157 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3204
US

IV. Provider business mailing address

801 S CHEVY CHASE DR #20
GLENDALE CA
91205-4431
US

V. Phone/Fax

Practice location:
  • Phone: 818-754-0959
  • Fax:
Mailing address:
  • Phone: 818-265-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: