Healthcare Provider Details

I. General information

NPI: 1245396803
Provider Name (Legal Business Name): NOUZHAN SEHATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-4815
  • Fax: 818-847-4842
Mailing address:
  • Phone: 818-847-4815
  • Fax: 818-847-4842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA79713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: