Healthcare Provider Details

I. General information

NPI: 1467896647
Provider Name (Legal Business Name): NILOOFARNOBAKHT,M.D.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 ATLANTIC AVE
LONG BEACH CA
90807-3418
US

IV. Provider business mailing address

PO BOX 1297
MANHATTAN BEACH CA
90267-1297
US

V. Phone/Fax

Practice location:
  • Phone: 323-230-0840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberA107561
License Number StateCA

VIII. Authorized Official

Name: DR. NILOOFAR NOBAKHT HAGHIGHI
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 720-341-3008