MEDICARE: MRS. CAROL R BAHARI RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	389901	CA

General Provider Information

NPI Number	:	1609112697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL R BAHARI RN

Provider Business Mailing Address
First Line	:	11611 ARROYO AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3002
Country	:	US
Telephone Number	:	714-269-5990
Fax Number	:

Provider Business Practice Location Address
First Line	:	11611 ARROYO AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3002
Country	:	US
Telephone Number	:	714-269-5990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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