Healthcare Provider Details

I. General information

NPI: 1053802470
Provider Name (Legal Business Name): NOOSHIN SALEHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 N MOUNT VERNON AVE
SAN BERNARDINO CA
92411-2661
US

IV. Provider business mailing address

5425 LA GRANDE
YORBA LINDA CA
92887-4010
US

V. Phone/Fax

Practice location:
  • Phone: 909-884-9091
  • Fax: 909-383-7013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA176954
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: