Provider Demographics
NPI:1700404357
Name:BANAYAN, ASHLEY NEGIN (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NEGIN
Last Name:BANAYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 WILSHIRE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2703
Mailing Address - Country:US
Mailing Address - Phone:310-652-0920
Mailing Address - Fax:310-360-4812
Practice Address - Street 1:8750 WILSHIRE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2703
Practice Address - Country:US
Practice Address - Phone:310-652-0920
Practice Address - Fax:310-360-4812
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59288363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical