Provider Demographics
NPI:1508970682
Name:GHORBANI, NOUROLLAH B (MD)
Entity Type:Individual
Prefix:DR
First Name:NOUROLLAH
Middle Name:B
Last Name:GHORBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LA CASA VIA STE 102
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3025
Mailing Address - Country:US
Mailing Address - Phone:925-946-9004
Mailing Address - Fax:925-946-9319
Practice Address - Street 1:130 LA CASA VIA STE 102
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3025
Practice Address - Country:US
Practice Address - Phone:925-946-9004
Practice Address - Fax:925-946-9319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40690OtherLICENSE NUMBER
CA00A406900Medicare ID - Type Unspecified