Provider Demographics
NPI:1336704279
Name:ZANDBIGLARI, SANAZ
Entity Type:Individual
Prefix:
First Name:SANAZ
Middle Name:
Last Name:ZANDBIGLARI
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 1:39 GROVE LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2102
Mailing Address - Country:US
Mailing Address - Phone:949-259-3700
Mailing Address - Fax:
Practice Address - Street 1:2035 NOVATO BLVD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-2191
Practice Address - Country:US
Practice Address - Phone:415-897-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist