Healthcare Provider Details

I. General information

NPI: 1013811355
Provider Name (Legal Business Name): SHADI SABERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 S RANCHO SANTA FE RD
SAN MARCOS CA
92078-3935
US

IV. Provider business mailing address

16265 STONEBRIDGE PKWY APT 725
SAN DIEGO CA
92131-4297
US

V. Phone/Fax

Practice location:
  • Phone: 760-599-0353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: