Provider Demographics
NPI:1346542743
Name:NOUROLLAH B. GHORBANI,M.D.INC.
Entity Type:Organization
Organization Name:NOUROLLAH B. GHORBANI,M.D.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOUROLLAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GHORBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-946-9004
Mailing Address - Street 1:130 LA CASA VIA
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3045
Mailing Address - Country:US
Mailing Address - Phone:925-946-9004
Mailing Address - Fax:925-946-9319
Practice Address - Street 1:130 LA CASA VIA
Practice Address - Street 2:SUITE 102
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3045
Practice Address - Country:US
Practice Address - Phone:925-946-9004
Practice Address - Fax:925-946-9319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40690261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1508970682OtherPHYSICIAN NPI
CAA29183Medicare UPIN