Healthcare Provider Details

I. General information

NPI: 1164904298
Provider Name (Legal Business Name): BAHAR RAHNAMA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 W OLYMPIC BLVD
LOS ANGELES CA
90064-5001
US

IV. Provider business mailing address

2275 CENTURY HL
LOS ANGELES CA
90067-3506
US

V. Phone/Fax

Practice location:
  • Phone: 424-284-8910
  • Fax:
Mailing address:
  • Phone: 310-892-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY32790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: