Provider Demographics
NPI:1942646393
Name:RUTHERFORD, SHERMIN YAGHOUBI (PA)
Entity Type:Individual
Prefix:MRS
First Name:SHERMIN
Middle Name:YAGHOUBI
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3599 SUELDO ST
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7386
Mailing Address - Country:US
Mailing Address - Phone:805-786-2500
Mailing Address - Fax:805-781-0423
Practice Address - Street 1:35 CASA ST STE 370
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5835
Practice Address - Country:US
Practice Address - Phone:805-541-1111
Practice Address - Fax:805-544-0834
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2019-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22866363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7179Medicare PIN