Provider Demographics
NPI:1558033399
Name:ABAD, SOHAN NICOLE
Entity Type:Individual
Prefix:
First Name:SOHAN
Middle Name:NICOLE
Last Name:ABAD
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 1:380 S 400 E APT 202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2926
Mailing Address - Country:US
Mailing Address - Phone:787-508-2648
Mailing Address - Fax:
Practice Address - Street 1:380 S 400 E APT 202
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2926
Practice Address - Country:US
Practice Address - Phone:787-508-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR