Provider Demographics
NPI:1679768931
Name:FOUAD M. NOURI M.D, INC
Entity Type:Organization
Organization Name:FOUAD M. NOURI M.D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FOUAD
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:NOURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-559-7311
Mailing Address - Street 1:10732 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4933
Mailing Address - Country:US
Mailing Address - Phone:310-559-7311
Mailing Address - Fax:310-559-7325
Practice Address - Street 1:10732 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4933
Practice Address - Country:US
Practice Address - Phone:310-559-7311
Practice Address - Fax:310-559-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA064212261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70992Medicare UPIN