Provider Demographics
NPI:1134492895
Name:BAKHTARY, MARIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:BAKHTARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-226-6811
Mailing Address - Fax:
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-226-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260216207RI0200X
CAA119180207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease