Provider Demographics
NPI:1679509871
Name:RASHTI, MANOUCHEHR (MD)
Entity Type:Individual
Prefix:
First Name:MANOUCHEHR
Middle Name:
Last Name:RASHTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49998
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-0998
Mailing Address - Country:US
Mailing Address - Phone:310-268-7707
Mailing Address - Fax:310-268-7708
Practice Address - Street 1:12340 SANTA MONICA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-0348
Practice Address - Country:US
Practice Address - Phone:310-268-7707
Practice Address - Fax:310-268-7708
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE99210Medicare UPIN