Provider Demographics
NPI:1477328813
Name:ASHOURPOUR, SOGOL (NMD)
Entity Type:Individual
Prefix:DR
First Name:SOGOL
Middle Name:
Last Name:ASHOURPOUR
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 S BEVERLY DR # 926
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3851
Mailing Address - Country:US
Mailing Address - Phone:310-466-0555
Mailing Address - Fax:
Practice Address - Street 1:113 N SAN VICENTE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2325
Practice Address - Country:US
Practice Address - Phone:310-466-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1471175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath