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General NPI Number Information
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NPI Number | 1174120349
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Entity Type | Organization
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Legal Business Name | J & M LAUREL MEDICAL CENTER INC
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 13680 VAN NUYS BLVD
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City | PACOIMA
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State | CA
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Zip | 91331-3616
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Country | US
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Telephone | 818-897-7730
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Fax | 818-897-7831
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Provider Business Mailing Address
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Address Line | 13680 VAN NUYS BLVD
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City | PACOIMA
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State | CA
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Zip | 91331-3616
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Country | US
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Telephone | 818-897-7730
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Fax | 818-897-7831
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAHANBAKHSH NOURI
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Credential | MD
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Telephone | 818-897-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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