Healthcare Provider Details

I. General information

NPI: 1336061241
Provider Name (Legal Business Name): MARYAM RAHBARIASL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAYA RAHBARIASL

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 ALGINET DR
ENCINO CA
91436-4123
US

IV. Provider business mailing address

3401 ALGINET DR
ENCINO CA
91436-4123
US

V. Phone/Fax

Practice location:
  • Phone: 310-997-6747
  • Fax:
Mailing address:
  • Phone: 310-997-6747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number19876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: