Healthcare Provider Details

I. General information

NPI: 1457832214
Provider Name (Legal Business Name): SABA AGHAZADEHMASROUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 20213
EL SOBRANTE CA
94820-0213
US

IV. Provider business mailing address

PO BOX 20213
EL SOBRANTE CA
94820-0213
US

V. Phone/Fax

Practice location:
  • Phone: 510-910-7872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW123460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: