Provider Demographics
NPI:1518554658
Name:DOROUDI, SAMIRA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SAMIRA
Middle Name:
Last Name:DOROUDI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 CAMINO ANDORRA UNIT 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6591
Mailing Address - Country:US
Mailing Address - Phone:760-845-3769
Mailing Address - Fax:
Practice Address - Street 1:1751 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7775
Practice Address - Country:US
Practice Address - Phone:760-208-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA839421835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty