Healthcare Provider Details

I. General information

NPI: 1063281954
Provider Name (Legal Business Name): ROXANA NOWBARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date: 05/01/2026
Reactivation Date: 07/29/2026

III. Provider practice location address

9500 GILMAN DR DEPT 602
LA JOLLA CA
92093-0602
US

IV. Provider business mailing address

4067 MIRAMAR ST # 5123
LA JOLLA CA
92037-1329
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-2230
  • Fax:
Mailing address:
  • Phone: 424-333-1067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: