Healthcare Provider Details

I. General information

NPI: 1700115961
Provider Name (Legal Business Name): BOBBY BABAK NOURANI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BOBBY NOURANI D.O.

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23101 LAKE CENTER DR STE 315
LAKE FOREST CA
92630-6812
US

IV. Provider business mailing address

23101 LAKE CENTER DR STE 315
LAKE FOREST CA
92630-6812
US

V. Phone/Fax

Practice location:
  • Phone: 546-546-2811
  • Fax: 810-202-7549
Mailing address:
  • Phone: 546-546-2811
  • Fax: 810-202-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A10928
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20A10928
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: