MEDICARE: DR. MOHAMAD BAKTASH NOORI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NI0013X	Independent Medical Examiner Chiropractor	DC30885	CA
2	111NN1001X	Nutrition Chiropractor	DC30885	CA

General Provider Information

NPI Number	:	1053571752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMAD BAKTASH NOORI DC

Provider Business Mailing Address
First Line	:	21586 CABROSA STR
Second Line	:	MISSION VEIJO
City	:	MISSION VEIJO
State	:	CA
Zip	:	92691
Country	:	US
Telephone Number	:	949-813-6896
Fax Number	:	949-582-5237

Provider Business Practice Location Address
First Line	:	21586 CABROSA
Second Line	:	MISSION VEIJO
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-1238
Country	:	US
Telephone Number	:	949-813-6896
Fax Number	:	949-582-5237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	06/16/2008

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