Provider Demographics
NPI:1568841252
Name:RAHBARVAFAEI, SALOUMEH (NP)
Entity Type:Individual
Prefix:MS
First Name:SALOUMEH
Middle Name:
Last Name:RAHBARVAFAEI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 ETIWANDA AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1646
Mailing Address - Country:US
Mailing Address - Phone:818-990-4100
Mailing Address - Fax:818-990-4199
Practice Address - Street 1:4849 VAN NUYS BLVD STE 217
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2128
Practice Address - Country:US
Practice Address - Phone:818-990-4100
Practice Address - Fax:818-990-4199
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002140363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner