Ida Rastegar, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

DR52958 Issued in CO

Practice address

14445 Olive View Dr
Dept OB/GYN 2B158
Sylmar, CA 91342-1437

Phone

(818) 364-3222

NPI assigned

Nov 2, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Becker Dermatology

  • MOHS-Micrographic Surgery Physician
  • Boulder, CO
  • NPI 1770822249
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1962581934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 30TH ST STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011237",
            "telephone_number": "303-444-0664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14445 OLIVE VIEW DR",
            "address_2": "DEPT OB/GYN 2B158",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913421437",
            "telephone_number": "818-364-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASTEGAR",
        "first_name": "IDA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A96030",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CO",
            "license": "DR52958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "DR052958",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@rinnovaskinandbody.com",
            "affiliation": "N",
            "address_1": "2600 30th St Ste 100",
            "city": "Boulder",
            "state": "CO",
            "country_code": "US",
            "postal_code": "803011237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Melissa Evelyn Ramos
• Amarjeet Kaur Randhawa, MD
• Sukhpreet Kaur Randhawa, PSYD
• Monica Rangel
• Gabriel Rashba
• Tiarra Kristina Ray
• RB Healthcare
• Edgar Recendez
• Jeison Danilo Recinos, M.D.
• Lorena Recinos, NP

• Obstetrics & Gynecology Physician in Sylmar, CA
• Providers in Sylmar, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.