Provider Demographics
NPI:1235916396
Name:BAKHTMAND, ARMITA (PA-C)
Entity Type:Individual
Prefix:
First Name:ARMITA
Middle Name:
Last Name:BAKHTMAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1090
Mailing Address - Country:US
Mailing Address - Phone:209-466-8546
Mailing Address - Fax:209-466-3335
Practice Address - Street 1:1617 N CALIFORNIA ST STE 2A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:206-466-8546
Practice Address - Fax:209-466-3335
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA63521363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant