Healthcare Provider Details

I. General information

NPI: 1245385343
Provider Name (Legal Business Name): KATAYOUN 0000 ROUSTA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 IRVINE BLVD
IRVINE CA
92620-2102
US

IV. Provider business mailing address

6300 IRVINE BLVD
IRVINE CA
92620-2102
US

V. Phone/Fax

Practice location:
  • Phone: 949-559-1139
  • Fax: 949-559-1776
Mailing address:
  • Phone: 949-559-1139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number49980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: