Provider Demographics
NPI:1811280746
Name:RASTEGAR, JESSICA CAROL (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:CAROL
Last Name:RASTEGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 468W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-255-0990
Mailing Address - Fax:310-255-0996
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 468W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-255-0990
Practice Address - Fax:310-255-0996
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA115366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology