Healthcare Provider Details

I. General information

NPI: 1912657594
Provider Name (Legal Business Name): LEILA NOGHREHCHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 N JASPER DR STE 3
FLAGSTAFF AZ
86001-1632
US

IV. Provider business mailing address

1200 N BEAVER ST ATTN: PAYER CREDENTIALING
FLAGSTAFF AZ
86001-3118
US

V. Phone/Fax

Practice location:
  • Phone: 928-913-8800
  • Fax:
Mailing address:
  • Phone: 928-213-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77504
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: