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General NPI Number Information
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NPI Number | 1578760229
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Entity Type | Individual
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Provider Name | DR. ROXANNA RAHBAN
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Gender | Female
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 15720 VENTURA BLVD #606
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City | ENCINO
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State | CA
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Zip | 91436-2914
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Country | US
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Telephone | 310-930-5033
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Fax |
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Provider Business Mailing Address
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Address Line | 6230 WILSHIRE BLVD # 870A
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City | LOS ANGELES
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State | CA
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Zip | 90048-5126
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY#25245
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License Number State | CA
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