Provider Demographics
NPI:1194851311
Name:MABOUDI, NILUFAR (MD)
Entity Type:Individual
Prefix:
First Name:NILUFAR
Middle Name:
Last Name:MABOUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4813
Mailing Address - Country:US
Mailing Address - Phone:916-483-2525
Mailing Address - Fax:
Practice Address - Street 1:651 FULTON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4813
Practice Address - Country:US
Practice Address - Phone:916-483-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068743207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
M180039877OtherRAIL ROAD MEDICARE
M180039877OtherRAIL ROAD MEDICARE
CAH06363Medicare UPIN
CA00A687430Medicare PIN