Provider Demographics
NPI:1750435442
Name:NSOULI, SAFA M (MD)
Entity type:Individual
Prefix:DR
First Name:SAFA
Middle Name:M
Last Name:NSOULI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4035
Mailing Address - Country:US
Mailing Address - Phone:925-831-8344
Mailing Address - Fax:925-831-2196
Practice Address - Street 1:905 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4035
Practice Address - Country:US
Practice Address - Phone:925-831-8344
Practice Address - Fax:925-831-2196
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42782261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29635Medicare UPIN