MEDICARE: BANAFSHEH BAYATI, M.D. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A68269	CA

General Provider Information

NPI Number	:	1952465973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANAFSHEH BAYATI, M.D. INC.

Provider Business Mailing Address
First Line	:	1450 10TH ST STE 305
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2831
Country	:	US
Telephone Number	:	424-348-3800
Fax Number	:	310-453-2563

Provider Business Practice Location Address
First Line	:	1450 10TH ST STE 305
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2831
Country	:	US
Telephone Number	:	424-348-3800
Fax Number	:	310-393-0353

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BANAFSHEH BAYATI
Credential	:	M.D.
Telephone Number	:	424-348-3800

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/03/2023

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