Provider Demographics
NPI:1942378369
Name:RASHTI, JALIL (MD)
Entity Type:Individual
Prefix:
First Name:JALIL
Middle Name:
Last Name:RASHTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16661 VENTURA BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1987
Mailing Address - Country:US
Mailing Address - Phone:818-386-1823
Mailing Address - Fax:818-907-0255
Practice Address - Street 1:16661 VENTURA BLVD STE 701
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1987
Practice Address - Country:US
Practice Address - Phone:818-386-1823
Practice Address - Fax:818-907-0255
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48983174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489830Medicaid
CAG41472Medicare UPIN
CA00A489830Medicaid