Provider Demographics
NPI:1003270745
Name:RASTGAR, YASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:YASHA
Middle Name:
Last Name:RASTGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4546 EL CAMINO REAL STE B7
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1069
Mailing Address - Country:US
Mailing Address - Phone:866-362-4246
Mailing Address - Fax:650-260-6030
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:BOX 9137
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-5323
Practice Address - Fax:304-293-8724
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1682432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry