Provider Demographics
NPI:1659497972
Name:GOLBAHAR, AKHTAR
Entity Type:Individual
Prefix:
First Name:AKHTAR
Middle Name:
Last Name:GOLBAHAR
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 1:16461 SLOAN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1157
Mailing Address - Country:US
Mailing Address - Phone:818-324-1156
Mailing Address - Fax:818-508-1726
Practice Address - Street 1:10847 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-2521
Practice Address - Country:US
Practice Address - Phone:818-324-1156
Practice Address - Fax:818-508-1726
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG024Medicare ID - Type Unspecified