Provider Demographics
NPI:1639180623
Name:NOURMAND, AZIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:AZIZ
Middle Name:
Last Name:NOURMAND
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 1:2001 SANTA MONICA BLVD STE 865W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2128
Mailing Address - Country:US
Mailing Address - Phone:310-829-3311
Mailing Address - Fax:310-582-1599
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 865W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2128
Practice Address - Country:US
Practice Address - Phone:310-829-3311
Practice Address - Fax:310-582-1599
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00C39151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C391511Medicaid
CAA87073Medicare UPIN