Healthcare Provider Details

I. General information

NPI: 1154868776
Provider Name (Legal Business Name): MEHRNOUSH GORJIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PEPPER AVE
COLTON CA
92324-1801
US

IV. Provider business mailing address

400 N PEPPER AVE
COLTON CA
92324-1801
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-1366
  • Fax: 909-580-1363
Mailing address:
  • Phone: 909-580-1366
  • Fax: 909-580-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA203084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: