Provider Demographics
NPI:1356643480
Name:NOURBAKHSH, AMIR M (DO)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:M
Last Name:NOURBAKHSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:AMIR
Other - Middle Name:
Other - Last Name:NORBAKSH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:5531 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5434
Mailing Address - Country:US
Mailing Address - Phone:949-315-8008
Mailing Address - Fax:
Practice Address - Street 1:5531 OHIO ST
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-5434
Practice Address - Country:US
Practice Address - Phone:949-315-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11461207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology