Provider Demographics
NPI:1508687682
Name:PAHLAVI, SODABA
Entity type:Individual
Prefix:
First Name:SODABA
Middle Name:
Last Name:PAHLAVI
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 1:2701 S 224TH ST APT E204
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6672
Mailing Address - Country:US
Mailing Address - Phone:206-593-8006
Mailing Address - Fax:
Practice Address - Street 1:15203 8TH AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1114
Practice Address - Country:US
Practice Address - Phone:206-593-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula