1942646393 NPI number — MRS. SHERMIN YAGHOUBI RUTHERFORD P.A.

Table of content: MRS. SHERMIN YAGHOUBI RUTHERFORD P.A. (NPI 1942646393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942646393 NPI number — MRS. SHERMIN YAGHOUBI RUTHERFORD P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTHERFORD
Provider First Name:
SHERMIN
Provider Middle Name:
YAGHOUBI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942646393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3599 SUELDO ST
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-7386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-786-2500
Provider Business Mailing Address Fax Number:
805-781-0423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 CASA ST STE 370
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93405-5835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-541-1111
Provider Business Practice Location Address Fax Number:
805-544-0834
Provider Enumeration Date:
05/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA22866 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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