Healthcare Provider Details

I. General information

NPI: 1013517457
Provider Name (Legal Business Name): RAMAN KHOSHABEH LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12650 SABRE SPRINGS PKWY STE 201
SAN DIEGO CA
92128-4114
US

IV. Provider business mailing address

PO BOX 503245
SAN DIEGO CA
92150-3245
US

V. Phone/Fax

Practice location:
  • Phone: 858-335-4900
  • Fax:
Mailing address:
  • Phone: 858-335-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number331571-00
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: