Organization
MARYAM RAHBAR, MD, INC.
Active
Other names
Pacific Coast Spine Institute and Pain Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARYAM RAHBAR (DIRECTOR)
(714) 847-3666
Entity
Organization
Contact information
Practice address
17822 BEACH BLVD STE 101, HUNTINGTON BEACH, CA 92647-7179
(714) 847-3666
(714) 847-7171
Mailing address
PO BOX 11869, NEWPORT BEACH, CA 92658-5044
(714) 847-3666
(714) 847-7171
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
AAAHC 77516
CA
261QP3300X
Pain Clinic/Center
A2677838
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D1073514
CLIA
CA
01
—
77516
AAAHC ACCREDITATION
CA
01
—
A267838
CITY BUSINESS LICENSE
CA
01
—
FNP36985
FICTITIOUS NAME PERMIT
CA
Enumeration date
12/18/2006
Last updated
10/16/2023
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