Provider Demographics
NPI:1891240594
Name:SOBHANIAN, SHAHAB (PA)
Entity Type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
Last Name:SOBHANIAN
Suffix:
Gender:M
Credentials:PA
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA STE 500
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7622
Mailing Address - Country:US
Mailing Address - Phone:949-855-1101
Mailing Address - Fax:949-855-8710
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA STE 500
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7622
Practice Address - Country:US
Practice Address - Phone:949-855-1101
Practice Address - Fax:949-855-8710
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2023-05-09
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant