Provider Demographics
NPI:1124043138
Name:GABBAY, NILOUFAR (PA-C)
Entity type:Individual
Prefix:MS
First Name:NILOUFAR
Middle Name:
Last Name:GABBAY
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 1:24711 VIA PRADERA
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1470
Mailing Address - Country:US
Mailing Address - Phone:818-489-7207
Mailing Address - Fax:
Practice Address - Street 1:120 S SPALDING DR STE 305
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1836
Practice Address - Country:US
Practice Address - Phone:310-829-5888
Practice Address - Fax:510-879-9100
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17461207T00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17461Medicaid
CAQ30008Medicare UPIN
CAPA17461Medicaid