MEDICARE: DR. AMIR NORBAKSH D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	20A11461	CA

General Provider Information

NPI Number	:	1356643480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR NORBAKSH D.O.

Provider Business Mailing Address
First Line	:	1968 S COAST HWY # 1983
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:	949-315-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1968 S COAST HWY # 1983
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3681
Country	:	US
Telephone Number	:	949-315-8008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	07/10/2024

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