=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831675073
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAHBA CHRISTIANSEN SAHBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2018
-----------------------------------------------------
Last Update Date | 07/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 951 AVENIDA PICO
-----------------------------------------------------
City | SAN CLEMENTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92673-3908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-498-6679
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 ORANGE BLOSSOM CIR
-----------------------------------------------------
City | LADERA RANCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92694-1253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-394-7740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 50868
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------