Provider Demographics
NPI:1831816016
Name:SABZEVARI, SOHEIL
Entity type:Individual
Prefix:
First Name:SOHEIL
Middle Name:
Last Name:SABZEVARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E VAUGHN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5975
Mailing Address - Country:US
Mailing Address - Phone:318-254-2453
Mailing Address - Fax:318-254-2728
Practice Address - Street 1:411 E VAUGHN AVE STE 104
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5975
Practice Address - Country:US
Practice Address - Phone:318-254-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2025-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301511070207X00000X
390200000X
LA344843207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program