Provider Demographics
NPI:1942013404
Name:GHORBANI, ASGHAR (ETC)
Entity type:Individual
Prefix:
First Name:ASGHAR
Middle Name:
Last Name:GHORBANI
Suffix:
Gender:M
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HOLLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6270
Mailing Address - Country:US
Mailing Address - Phone:916-586-0279
Mailing Address - Fax:
Practice Address - Street 1:34 HOLLIDAY DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6270
Practice Address - Country:US
Practice Address - Phone:916-586-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF00110912247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist