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NPI Code Detail

MEDICARE: NOOSHA C AMIRI-DAVANI M.D.

MEDICARE: NOOSHA C AMIRI-DAVANI M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207P00000XEmergency Medicine PhysicianA107386CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A107386OTHERCAMEDICAL LICENSE

General Provider Information

NPI Number : 1083881122
Entity Type Code : Individual
Provider Name (Legal Business Name) : NOOSHA C AMIRI-DAVANI M.D.
Provider Business Mailing Address
First Line : PO BOX 661465
Second Line :
City : ARCADIA
State : CA
Zip : 91066-1465
Country : US
Telephone Number : 626-447-0296
Fax Number : 626-447-6057
Provider Business Practice Location Address
First Line : 14850 ROSCOE BLVD
Second Line :
City : PANORAMA CITY
State : CA
Zip : 91402-4618
Country : US
Telephone Number : 818-904-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2008
Last Update Date : 05/10/2012

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