Provider Demographics
NPI:1124793849
Name:EBRAHIMI-NUYKEN, SORAYA
Entity type:Individual
Prefix:
First Name:SORAYA
Middle Name:
Last Name:EBRAHIMI-NUYKEN
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 1:516 DOUGLAS STREET
Mailing Address - Street 2:APARTMENT 302
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605
Mailing Address - Country:US
Mailing Address - Phone:530-277-8103
Mailing Address - Fax:
Practice Address - Street 1:8421 AUBURN BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-0391
Practice Address - Country:US
Practice Address - Phone:916-512-8420
Practice Address - Fax:916-722-9229
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW100380104100000X
CA1273621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker