MEDICARE: EL NUDO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043896921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL NUDO, LLC

Provider Business Mailing Address
First Line	:	455 N MAGNOLIA AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3606
Country	:	US
Telephone Number	:	619-442-0303
Fax Number	:	619-442-0305

Provider Business Practice Location Address
First Line	:	455 N MAGNOLIA AVE
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-3606
Country	:	US
Telephone Number	:	619-442-0303
Fax Number	:	619-442-0305

Authorized Official
Title or Position	:	PIC/OWNER
Name	:	DR. BIJAN JAMIE SABOURI
Credential	:	PHARM.D.
Telephone Number	:	858-531-3151

Provider Enumeration Date	:	03/22/2021
Last Update Date	:	03/07/2023

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Directions to “EL NUDO, LLC ” Practice Location

Language	Start Address	Practice Location

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