Provider Demographics
NPI:1053666974
Name:ZARBAKHSH, SIPORA (RPA-C)
Entity Type:Individual
Prefix:
First Name:SIPORA
Middle Name:
Last Name:ZARBAKHSH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:SIPOURA
Other - Middle Name:
Other - Last Name:ZADMEHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:16952 VENTURA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4193
Mailing Address - Country:US
Mailing Address - Phone:818-795-7071
Mailing Address - Fax:
Practice Address - Street 1:16952 VENTURA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4193
Practice Address - Country:US
Practice Address - Phone:818-795-7071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014798363AM0700X
CA51417363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical