Basic Information
| Provider Information | |||||||||
| NPI: | 1649621954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BABARAN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12160 CRYSTAL RIDGE WAY | ||||||||
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| City: | PORTER RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913263800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182747357 | ||||||||
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| Practice Location | |||||||||
| Address1: | 80 SEYMOUR ST | ||||||||
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| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061028000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609726230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2016 | ||||||||
| LastUpdateDate: | 06/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 3578 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.