Provider Demographics
NPI:1770503161
Name:RABBANI, FARHAD (MD)
Entity Type:Individual
Prefix:MR
First Name:FARHAD
Middle Name:
Last Name:RABBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FARHAD
Other - Middle Name:
Other - Last Name:RABBANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16550 VENTURA BLVD #200
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:310-657-7676
Mailing Address - Fax:818-501-5332
Practice Address - Street 1:16550 VENTURA BLVD #200
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:310-657-7676
Practice Address - Fax:818-501-5332
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44623207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A446230Medicaid
CAA44623Medicare PIN
C35576Medicare UPIN