Provider Demographics
NPI:1659537306
Name:NOORISTANI, AHMAD K (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:K
Last Name:NOORISTANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 BLUEROCK DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5678
Mailing Address - Country:US
Mailing Address - Phone:805-821-1176
Mailing Address - Fax:805-439-2364
Practice Address - Street 1:830 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4699
Practice Address - Country:US
Practice Address - Phone:805-922-6657
Practice Address - Fax:805-439-2364
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104544207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA104544OtherCA MEDICAL LICENSE
CAA104544OtherCA MEDICAL LICENSE