Healthcare Provider Details

I. General information

NPI: 1427673573
Provider Name (Legal Business Name): BOBBY NOURANI D.O MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 7TH PL APT 709
LONG BEACH CA
90802-5872
US

IV. Provider business mailing address

21 7TH PL APT 709
LONG BEACH CA
90802-5872
US

V. Phone/Fax

Practice location:
  • Phone: 562-546-2811
  • Fax: 810-202-7549
Mailing address:
  • Phone: 562-546-2811
  • Fax: 810-202-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BOBBY NOURANI
Title or Position: CEO/OWNER
Credential: DO
Phone: 562-546-2811