Provider Demographics
NPI:1295750164
Name:MAHBOUBIAN, SOHAIL S (MD)
Entity type:Individual
Prefix:DR
First Name:SOHAIL
Middle Name:S
Last Name:MAHBOUBIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 260130
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0130
Mailing Address - Country:US
Mailing Address - Phone:818-379-9991
Mailing Address - Fax:818-995-0208
Practice Address - Street 1:16133 VENTURA BLVD STE 415
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2429
Practice Address - Country:US
Practice Address - Phone:818-379-9991
Practice Address - Fax:818-995-0208
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69412207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A694120Medicaid
H01078Medicare UPIN
CA00A694120Medicaid