Healthcare Provider Details

I. General information

NPI: 1841600509
Provider Name (Legal Business Name): WENDY GRANT SABOURI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2014
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26891 ALISO CREEK RD
ALISO VIEJO CA
92656-3392
US

IV. Provider business mailing address

30041 TESSIER APT 107
LAGUNA NIGUEL CA
92677-8943
US

V. Phone/Fax

Practice location:
  • Phone: 949-360-4081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: