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General NPI Number Information
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NPI Number | 1700404357
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Entity Type | Individual
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Provider Name | ASHLEY NEGIN BANAYAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 8750 WILSHIRE BLVD STE 210
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2703
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Country | US
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Telephone | 310-652-0920
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Fax | 310-360-4812
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Provider Business Mailing Address
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Address Line | 8750 WILSHIRE BLVD STE 210
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-2703
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Country | US
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Telephone | 310-652-0920
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Fax | 310-360-4812
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA59288
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License Number State | CA
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