Provider Demographics
NPI:1952071094
Name:KHOOBBAYAN, RONIT (PA-C)
Entity Type:Individual
Prefix:
First Name:RONIT
Middle Name:
Last Name:KHOOBBAYAN
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 1:4900 ALONZO AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3608
Mailing Address - Country:US
Mailing Address - Phone:818-277-4763
Mailing Address - Fax:
Practice Address - Street 1:4900 ALONZO AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3608
Practice Address - Country:US
Practice Address - Phone:818-277-4763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant