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General NPI Number Information
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NPI Number | 1932736451
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Entity Type | Individual
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Provider Name | BOBAK THOMAS POUSTI
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Gender | Male
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 655 EUCLID AVE STE 304
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2974
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Country | US
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Telephone | 619-267-8303
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Fax | 619-267-4835
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Provider Business Mailing Address
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Address Line | 8899 UNIVERSITY CENTER LN STE 350
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City | SAN DIEGO
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State | CA
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Zip | 92122-1010
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Country | US
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Telephone | 858-657-8322
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 1932736451
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License Number State | CA
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