Healthcare Provider Details

I. General information

NPI: 1831816016
Provider Name (Legal Business Name): SOHEIL SABZEVARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E VAUGHN AVE STE 104
RUSTON LA
71270-5975
US

IV. Provider business mailing address

411 E VAUGHN AVE STE 104
RUSTON LA
71270-5975
US

V. Phone/Fax

Practice location:
  • Phone: 318-254-2453
  • Fax:
Mailing address:
  • Phone: 318-254-2453
  • Fax: 318-254-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301511070
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number344843
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: