Healthcare Provider Details

I. General information

NPI: 1053571752
Provider Name (Legal Business Name): MOHAMAD BAKTASH NOORI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOHAMAD BAKTASH NOORI DC DOCTOR OF CHIRO

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21586 CABROSA MISSION VEIJO
MISSION VIEJO CA
92691-1238
US

IV. Provider business mailing address

21586 CABROSA STR MISSION VEIJO
MISSION VEIJO CA
92691
US

V. Phone/Fax

Practice location:
  • Phone: 949-813-6896
  • Fax: 949-582-5237
Mailing address:
  • Phone: 949-813-6896
  • Fax: 949-582-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC30885
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC30885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: