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NPI Code Detail

MEDICARE: DR. GHULAM RAZA NOORANI MD

MEDICARE: DR. GHULAM RAZA NOORANI MD
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
12084P0800XPsychiatry PhysicianA069452CA

General Provider Information

NPI Number : 1417900069
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GHULAM RAZA NOORANI MD
Provider Business Mailing Address
First Line : 2101 COURAGE DR
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6717
Country : US
Telephone Number : 707-784-2080
Fax Number :
Provider Business Practice Location Address
First Line : 2101 COURAGE DR
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6717
Country : US
Telephone Number : 707-784-8020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 12/16/2021

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