Healthcare Provider Details

I. General information

NPI: 1790612919
Provider Name (Legal Business Name): ELHUM MEHRABANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

178 ELDER AVE
MILLBRAE CA
94030-2427
US

V. Phone/Fax

Practice location:
  • Phone: 510-364-3596
  • Fax:
Mailing address:
  • Phone: 510-364-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH90053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: