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General NPI Number Information
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NPI Number | 1447598222
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Entity Type | Organization
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Legal Business Name | REYMUNDO NOUR
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 81626 US HIGHWAY 111
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City | INDIO
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State | CA
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Zip | 92201-5413
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Country | US
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Telephone | 760-600-5825
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Fax |
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Provider Business Mailing Address
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Address Line | 81626 US HIGHWAY 111
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City | INDIO
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State | CA
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Zip | 92201-5413
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Country | US
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Telephone | 760-600-5825
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | REYMUNDO NOUR
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Credential |
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Telephone | 760-600-5825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CLR00343403
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CLR00343403
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License Number State | CA
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