Provider Demographics
NPI:1992868368
Name:RAHBAR, MARYAM (MD)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:RAHBAR
Suffix:
Gender:F
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:PO BOX 11869
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5044
Mailing Address - Country:US
Mailing Address - Phone:714-863-8567
Mailing Address - Fax:714-847-7171
Practice Address - Street 1:17822 BEACH BLVD STE 152
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7114
Practice Address - Country:US
Practice Address - Phone:714-847-3666
Practice Address - Fax:714-847-7171
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80577208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0-463-8987OtherECFMG
CAA80577OtherSTATE LICENSE
CABR7288574/XR7288574OtherDEA
CABR7288574/XR7288574OtherDEA