Provider Demographics
NPI:1184279606
Name:NEW VISION TELEMEDICINE AND MEDICAL CONSULTANT, INC.
Entity type:Organization
Organization Name:NEW VISION TELEMEDICINE AND MEDICAL CONSULTANT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:NOORISTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-821-1176
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:
Mailing Address - Fax:
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:93454-4610
Practice Address - Country:US
Practice Address - Phone:805-821-1176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty