Provider Demographics
NPI:1598111544
Name:SHABBOUEI, YASAMIN
Entity Type:Individual
Prefix:
First Name:YASAMIN
Middle Name:
Last Name:SHABBOUEI
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 1:900 VIA DE LA PAZ
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3549
Mailing Address - Country:US
Mailing Address - Phone:310-454-0377
Mailing Address - Fax:310-454-0378
Practice Address - Street 1:900 VIA DE LA PAZ
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3549
Practice Address - Country:US
Practice Address - Phone:310-454-0377
Practice Address - Fax:310-454-0378
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH419171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist