Provider Demographics
NPI:1972052967
Name:SOBHANI, NASIMALSADAT
Entity Type:Individual
Prefix:
First Name:NASIMALSADAT
Middle Name:
Last Name:SOBHANI
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:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-0656
Mailing Address - Country:US
Mailing Address - Phone:949-259-3095
Mailing Address - Fax:
Practice Address - Street 1:1905 MONUMENT BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-3858
Practice Address - Country:US
Practice Address - Phone:925-680-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 73764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist