Provider Demographics
NPI:1205457918
Name:NOORISTANI, ABDULLA
Entity type:Individual
Prefix:
First Name:ABDULLA
Middle Name:
Last Name:NOORISTANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 BUSINESS DR STE D
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-2179
Mailing Address - Country:US
Mailing Address - Phone:916-452-8022
Mailing Address - Fax:
Practice Address - Street 1:3630 BUSINESS DR STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-2179
Practice Address - Country:US
Practice Address - Phone:916-452-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593301835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric