Provider Demographics
NPI:1639724941
Name:ABOUTORABIAN, NEGIN ALAM (OD)
Entity Type:Individual
Prefix:DR
First Name:NEGIN
Middle Name:ALAM
Last Name:ABOUTORABIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 PURDUE AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3288
Mailing Address - Country:US
Mailing Address - Phone:310-622-5992
Mailing Address - Fax:
Practice Address - Street 1:125 E GONZALES RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-8259
Practice Address - Country:US
Practice Address - Phone:805-485-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34314152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist