Provider Demographics
NPI:1528154192
Name:DARVISH, BABAK K (MD)
Entity type:Individual
Prefix:DR
First Name:BABAK
Middle Name:K
Last Name:DARVISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:DEPT. OF PM&R, MAIL CODE #117
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4995
Practice Address - Street 1:17525 VENTURA BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3843
Practice Address - Country:US
Practice Address - Phone:818-225-5362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65838208100000X, 2081N0008X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine