Healthcare Provider Details

I. General information

NPI: 1831716463
Provider Name (Legal Business Name): MICHELLE MINA RASTEGAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W OLYMPIC BLVD STE 310
LOS ANGELES CA
90036-4664
US

IV. Provider business mailing address

318 N ARDEN BLVD
LOS ANGELES CA
90004-3022
US

V. Phone/Fax

Practice location:
  • Phone: 323-215-1725
  • Fax:
Mailing address:
  • Phone: 323-327-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2020019050
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA202034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: