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General NPI Number Information
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NPI Number | 1346542743
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Entity Type | Organization
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Legal Business Name | NOUROLLAH B. GHORBANI,M.D.INC.
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 130 LA CASA VIA SUITE 102
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3045
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Country | US
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Telephone | 925-946-9004
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Fax | 925-946-9319
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Provider Business Mailing Address
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Address Line | 130 LA CASA VIA SUITE 102
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City | WALNUT CREEK
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State | CA
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Zip | 94598-3045
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Country | US
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Telephone | 925-946-9004
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Fax | 925-946-9319
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NOUROLLAH B. GHORBANI
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Credential | M.D.
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Telephone | 925-946-9004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A40690
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License Number State | CA
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