Provider Demographics
NPI:1710553268
Name:EHSAN, RAHAL (NP)
Entity Type:Individual
Prefix:
First Name:RAHAL
Middle Name:
Last Name:EHSAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23756 SANDHURST LN
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1419
Mailing Address - Country:US
Mailing Address - Phone:310-997-2269
Mailing Address - Fax:
Practice Address - Street 1:23756 SANDHURST LN
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-1419
Practice Address - Country:US
Practice Address - Phone:310-997-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95017458Medicaid
CA95017458OtherMEDI-CAL