Healthcare Provider Details

I. General information

NPI: 1427797950
Provider Name (Legal Business Name): MIRETTE SAMIR RAMZI GHOBRIAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3535
US

IV. Provider business mailing address

2995 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3535
US

V. Phone/Fax

Practice location:
  • Phone: 992-525-6723
  • Fax:
Mailing address:
  • Phone: 925-256-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: