Provider Demographics
NPI:1619509064
Name:BAKHAJ, ASHLEY REBECCA
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REBECCA
Last Name:BAKHAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9675 BRIGHTON WAY STE 250
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5180
Mailing Address - Country:US
Mailing Address - Phone:310-278-5337
Mailing Address - Fax:
Practice Address - Street 1:9675 BRIGHTON WAY
Practice Address - Street 2:STE 250
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5180
Practice Address - Country:US
Practice Address - Phone:310-278-5337
Practice Address - Fax:310-278-6204
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50525225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant