Provider Demographics
NPI:1184214058
Name:MOHEBALI, NILOOFAR
Entity Type:Individual
Prefix:
First Name:NILOOFAR
Middle Name:
Last Name:MOHEBALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3043
Mailing Address - Country:US
Mailing Address - Phone:707-888-9676
Mailing Address - Fax:
Practice Address - Street 1:4537 EDISON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3043
Practice Address - Country:US
Practice Address - Phone:707-888-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician