Healthcare Provider Details

I. General information

NPI: 1477328813
Provider Name (Legal Business Name): SOGOL ASHOURPOUR NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N SAN VICENTE BLVD FL 2
BEVERLY HILLS CA
90211-2325
US

IV. Provider business mailing address

269 S BEVERLY DR # 926
BEVERLY HILLS CA
90212-3851
US

V. Phone/Fax

Practice location:
  • Phone: 310-466-0555
  • Fax:
Mailing address:
  • Phone: 310-466-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: