Provider Demographics
NPI:1811224405
Name:NOURIAN, ARDALAN ALEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ARDALAN
Middle Name:ALEN
Last Name:NOURIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEN
Other - Middle Name:
Other - Last Name:NOURIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 15426
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-1426
Mailing Address - Country:US
Mailing Address - Phone:310-702-1872
Mailing Address - Fax:310-606-2039
Practice Address - Street 1:301 SCIENCE DR STE 190
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-0800
Practice Address - Country:US
Practice Address - Phone:310-702-1872
Practice Address - Fax:310-606-2039
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128908207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA128908OtherSTATE LICENSE
CAA128908OtherSTATE LICENSE