Provider Demographics
NPI:1124699152
Name:EL NUDO, LLC
Entity type:Organization
Organization Name:EL NUDO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:JAMIE
Authorized Official - Last Name:SABOURI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:858-771-7791
Mailing Address - Street 1:4122 SORRENTO VALLEY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1431
Mailing Address - Country:US
Mailing Address - Phone:858-771-7791
Mailing Address - Fax:888-239-6337
Practice Address - Street 1:4122 SORRENTO VALLEY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1431
Practice Address - Country:US
Practice Address - Phone:858-531-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy