Provider Demographics
NPI:1760463764
Name:NOWROOZI, FRED E (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:E
Last Name:NOWROOZI
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 1:1501 N PLACENTIA AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-2332
Mailing Address - Country:US
Mailing Address - Phone:714-223-7000
Mailing Address - Fax:714-223-7001
Practice Address - Street 1:1501 N PLACENTIA AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-2332
Practice Address - Country:US
Practice Address - Phone:714-223-7000
Practice Address - Fax:714-223-7001
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA363802081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A363800Medicaid
CAA36380OtherSTATE LICENSE
CAA36380OtherSTATE LICENSE
W16024Medicare ID - Type Unspecified
A28067Medicare UPIN