Healthcare Provider Details

I. General information

NPI: 1649719204
Provider Name (Legal Business Name): NAUDEREH NOORI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 29A
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S BLDG 29A
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7012
  • Fax:
Mailing address:
  • Phone: 714-456-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number146284
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberA146284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: