Provider Demographics
NPI:1295367860
Name:ZAGHI, REBECCA ROKHSAR (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROKHSAR
Last Name:ZAGHI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:REBEKA
Other - Middle Name:
Other - Last Name:ROKHSAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6224 BEEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3121
Mailing Address - Country:US
Mailing Address - Phone:310-926-3147
Mailing Address - Fax:
Practice Address - Street 1:1004 N SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2330
Practice Address - Country:US
Practice Address - Phone:626-445-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA795417163WS0121X
CAF01201713363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery