Healthcare Provider Details

I. General information

NPI: 1366987828
Provider Name (Legal Business Name): SHAHRZAD KHOOBYARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 WEBB CT
REDDING CA
96002-1541
US

IV. Provider business mailing address

2520 WEBB CT
REDDING CA
96002-1541
US

V. Phone/Fax

Practice location:
  • Phone: 949-278-8899
  • Fax:
Mailing address:
  • Phone: 949-278-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: