Healthcare Provider Details

I. General information

NPI: 1396611869
Provider Name (Legal Business Name): ASEALA ABOUSAUD PHARMD, BCOP, APH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 LA CASA VIA STE 300
WALNUT CREEK CA
94598-6101
US

IV. Provider business mailing address

99 ASPEN LN
PITTSBURG CA
94565-5490
US

V. Phone/Fax

Practice location:
  • Phone: 925-692-5647
  • Fax: 925-692-5908
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number90732
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number90732
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number90732
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number90732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: