Healthcare Provider Details

I. General information

NPI: 1639724941
Provider Name (Legal Business Name): NEGIN ALAM ABOUTORABIAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2019
Last Update Date: 08/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E GONZALES RD
OXNARD CA
93036-8259
US

IV. Provider business mailing address

1505 PURDUE AVE APT 303
LOS ANGELES CA
90025-3288
US

V. Phone/Fax

Practice location:
  • Phone: 805-485-4854
  • Fax:
Mailing address:
  • Phone: 310-622-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: