Provider Demographics
NPI:1467017053
Name:NABI, SUFIA
Entity Type:Individual
Prefix:
First Name:SUFIA
Middle Name:
Last Name:NABI
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 1:9850 19TH ST APT 144
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-4225
Mailing Address - Country:US
Mailing Address - Phone:909-210-5390
Mailing Address - Fax:
Practice Address - Street 1:9850 19TH ST APT 144
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91737-4225
Practice Address - Country:US
Practice Address - Phone:909-210-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAEF1521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist