Healthcare Provider Details

I. General information

NPI: 1972457661
Provider Name (Legal Business Name): YAGHMA NOROUZI AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 02/21/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 VENTURA BLVD STE 305
ENCINO CA
91436-4667
US

IV. Provider business mailing address

19160 MARILLA ST
NORTHRIDGE CA
91324-1735
US

V. Phone/Fax

Practice location:
  • Phone: 818-934-9040
  • Fax:
Mailing address:
  • Phone: 310-430-3136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95013870
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95013870
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95013870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: