MEDICARE: SADEGH NOBARI MFT

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	106H00000X	Marriage & Family Therapist	MFC 36530	CA

General Provider Information

NPI Number	:	1104848167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADEGH NOBARI MFT

Provider Business Mailing Address
First Line	:	3230 KERNER BLVD
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-4840
Country	:	US
Telephone Number	:	415-328-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 KERNER BLVD
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-4840
Country	:	US
Telephone Number	:	415-328-9797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	12/17/2008

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Directions to “ SADEGH NOBARI MFT” Practice Location

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