Provider Demographics
NPI:1972929438
Name:BAGHOUMIAN, MARINEH (OD)
Entity type:Individual
Prefix:DR
First Name:MARINEH
Middle Name:
Last Name:BAGHOUMIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20700 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3701
Mailing Address - Country:US
Mailing Address - Phone:310-532-2622
Mailing Address - Fax:
Practice Address - Street 1:435 ARDEN AVE STE 430
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4022
Practice Address - Country:US
Practice Address - Phone:818-539-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist