Provider Demographics
NPI:1902687767
Name:GHOBADI, TAHMEENEH
Entity Type:Individual
Prefix:
First Name:TAHMEENEH
Middle Name:
Last Name:GHOBADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 KENSINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9365
Mailing Address - Country:US
Mailing Address - Phone:209-996-2663
Mailing Address - Fax:
Practice Address - Street 1:2955 N TEGNER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-9401
Practice Address - Country:US
Practice Address - Phone:209-656-5328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist