Provider Demographics
NPI:1619179454
Name:RABBANI, NIMA (DO, MS)
Entity Type:Individual
Prefix:
First Name:NIMA
Middle Name:
Last Name:RABBANI
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16133 VENTURA BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2426
Mailing Address - Country:US
Mailing Address - Phone:818-986-6009
Mailing Address - Fax:
Practice Address - Street 1:16133 VENTURA BLVD STE 360
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2426
Practice Address - Country:US
Practice Address - Phone:818-986-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9740207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12512870OtherCAQH
CA0020A9740Medicaid
CD204VMedicare PIN