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General NPI Number Information
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NPI Number | 1245393602
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Entity Type | Organization
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Legal Business Name | MARYAM RAHBAR, MD, INC.
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 17822 BEACH BLVD STE 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-7179
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Country | US
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Telephone | 714-847-3666
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Fax | 714-847-7171
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Provider Business Mailing Address
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Address Line | PO BOX 11869
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-5044
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Country | US
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Telephone | 714-847-3666
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Fax | 714-847-7171
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARYAM RAHBAR
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Credential |
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Telephone | 714-847-3666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | A2677838
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | AAAHC 77516
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License Number State | CA
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