MEDICARE: MITRA RAJABI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95024823	CA

General Provider Information

NPI Number	:	1710674106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITRA RAJABI NP

Provider Business Mailing Address
First Line	:	955 CARRILLO DR STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5475
Country	:	US
Telephone Number	:	424-258-0124
Fax Number	:	310-602-6515

Provider Business Practice Location Address
First Line	:	955 CARRILLO DR STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5475
Country	:	US
Telephone Number	:	424-258-0124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	10/16/2025

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