Healthcare Provider Details

I. General information

NPI: 1376108340
Provider Name (Legal Business Name): BAHRAM RABBANI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL ARSALAN

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

2025 MORSE AVE 3RD FLOOR, STATION A
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-5175
  • Fax:
Mailing address:
  • Phone: 916-973-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number7076
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A21318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: