Provider Demographics
NPI:1861077497
Name:GIDANIAN, YAEL (OTR/L)
Entity type:Individual
Prefix:
First Name:YAEL
Middle Name:
Last Name:GIDANIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 GLENVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3120
Mailing Address - Country:US
Mailing Address - Phone:310-595-8661
Mailing Address - Fax:
Practice Address - Street 1:8501 WILSHIRE BLVD STE 336
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3134
Practice Address - Country:US
Practice Address - Phone:310-659-9511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21592OtherCBOT