Healthcare Provider Details

I. General information

NPI: 1659742906
Provider Name (Legal Business Name): ALI REZA YASSERI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NAPA VALLEJO HWY
NAPA CA
94558-6234
US

IV. Provider business mailing address

832 OXFORD WAY
BENICIA CA
94510-3673
US

V. Phone/Fax

Practice location:
  • Phone: 707-253-5999
  • Fax:
Mailing address:
  • Phone: 530-908-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number61464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: