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1396611869 NPI number — ASEALA ABOUSAUD PHARMD, BCOP, APH

NPI Number: 1396611869
Health Care Provider/Practitioner: ASEALA ABOUSAUD PHARMD, BCOP, APH

Information about “1396611869” NPI (ASEALA ABOUSAUD PHARMD, BCOP, APH) exists in 1396611869 in HTML format HTML  |  1396611869 in plain Text format TXT  |  1396611869 in PDF (Portable Document Format) PDF  |  1396611869 in an XML format XML  formats.

NPI Number : 1396611869 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396611869",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ABOUSAUD",
    "FirstName": "ASEALA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD, BCOP, APH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "99 ASPEN LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PITTSBURG",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94565-5490",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "177 LA CASA VIA STE 300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WALNUT CREEK",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94598-6101",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "925-692-5647",
    "PracticeLocationAddressFaxNumber": "925-692-5908",
    "EnumerationDate": "10/13/2025",
    "LastUpdateDate": "10/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1835P0018X",
          "TaxonomyName": "Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
          "LicenseNumber": "90732",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1835P1200X",
          "TaxonomyName": "Pharmacotherapy Pharmacist",
          "LicenseNumber": "90732",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1835P2201X",
          "TaxonomyName": "Ambulatory Care Pharmacist",
          "LicenseNumber": "90732",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1835X0200X",
          "TaxonomyName": "Oncology Pharmacist",
          "LicenseNumber": "90732",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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