Provider Demographics
NPI:1245622232
Name:BITA NOORANBAKHT MD LLC
Entity type:Organization
Organization Name:BITA NOORANBAKHT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-718-5983
Mailing Address - Street 1:3225 N 75TH ST
Mailing Address - Street 2:SUITE125
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6909
Mailing Address - Country:US
Mailing Address - Phone:480-718-5986
Mailing Address - Fax:480-947-2494
Practice Address - Street 1:3225 N 75TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6909
Practice Address - Country:US
Practice Address - Phone:480-718-5986
Practice Address - Fax:480-947-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30670261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center