Healthcare Provider Details

I. General information

NPI: 1952310799
Provider Name (Legal Business Name): BABAK BARAVARIAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2121 WILSHIRE BLVD SUITE 101
SANTA MONICA CA
90403
US

IV. Provider business mailing address

2121 WILSHIRE BLVD SUITE 101
SANTA MONICA CA
90403
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-0011
  • Fax: 310-828-2001
Mailing address:
  • Phone: 310-828-0011
  • Fax: 310-828-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: