Provider Demographics
NPI:1760752596
Name:SABBAR, ANAHITA GHODSIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANAHITA
Middle Name:GHODSIAN
Last Name:SABBAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANAHITA
Other - Middle Name:
Other - Last Name:GHODSIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2020 SANTA MONICA BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2023
Mailing Address - Country:US
Mailing Address - Phone:310-582-7313
Mailing Address - Fax:
Practice Address - Street 1:2021 SANTA MONICA BLVD STE 625E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2169
Practice Address - Country:US
Practice Address - Phone:310-829-8948
Practice Address - Fax:424-212-5937
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant