Provider Demographics
NPI:1972394641
Name:RANJBAR, JESSICA (NP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RANJBAR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 BRAMFORD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1101
Mailing Address - Country:US
Mailing Address - Phone:818-983-2626
Mailing Address - Fax:
Practice Address - Street 1:380 S LAKE AVE STE 101B
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3525
Practice Address - Country:US
Practice Address - Phone:626-989-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF05250153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily