Provider Demographics
NPI:1841589686
Name:YOUABIAN, OMID (RPH)
Entity Type:Individual
Prefix:
First Name:OMID
Middle Name:
Last Name:YOUABIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 S WESTGATE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5217
Mailing Address - Country:US
Mailing Address - Phone:310-806-1163
Mailing Address - Fax:
Practice Address - Street 1:875 N ALTA AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-3002
Practice Address - Country:US
Practice Address - Phone:559-595-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist