Provider Demographics
NPI:1477669745
Name:BAYATI, BANAFSHEH (MD)
Entity type:Individual
Prefix:DR
First Name:BANAFSHEH
Middle Name:
Last Name:BAYATI
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 1:1450 10TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2831
Mailing Address - Country:US
Mailing Address - Phone:424-348-3800
Mailing Address - Fax:310-393-0353
Practice Address - Street 1:1450 10TH ST STE 305
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2831
Practice Address - Country:US
Practice Address - Phone:424-348-3800
Practice Address - Fax:310-393-0353
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68269207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology