Provider Demographics
NPI:1679729453
Name:BONYADI, BAHAREH (DO)
Entity type:Individual
Prefix:MS
First Name:BAHAREH
Middle Name:
Last Name:BONYADI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:BAHAREH
Other - Middle Name:
Other - Last Name:BONYADI DEHDEHBEGLOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:801 N TUSTIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3612
Mailing Address - Country:US
Mailing Address - Phone:714-486-2662
Mailing Address - Fax:714-242-1874
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3612
Practice Address - Country:US
Practice Address - Phone:714-486-2662
Practice Address - Fax:714-242-1874
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A128052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology