Provider Demographics
NPI:1851905624
Name:KESHAVARZ RAHBAR, AIDA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:
Last Name:KESHAVARZ RAHBAR
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 1:1311 N. SAN FERNANDO BLVD,
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504
Mailing Address - Country:US
Mailing Address - Phone:818-843-9900
Mailing Address - Fax:818-843-9909
Practice Address - Street 1:1311 N. SAN FERNANDO BLVD,
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504
Practice Address - Country:US
Practice Address - Phone:818-843-9900
Practice Address - Fax:818-843-9909
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPA62411390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program