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General NPI Number Information
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NPI Number | 1831716463
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Entity Type | Individual
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Provider Name | MICHELLE MINA RASTEGAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 907 PICO BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90405-1326
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Country | US
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Telephone | 310-314-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 318 N ARDEN BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-3022
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Country | US
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Telephone | 323-327-3923
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2020019050
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A202034
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License Number State | CA
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