Provider Demographics
NPI:1740629211
Name:NOURI, SARVENAZ (MD)
Entity type:Individual
Prefix:MRS
First Name:SARVENAZ
Middle Name:
Last Name:NOURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36320 INLAND VALLEY DR.
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7512
Mailing Address - Country:US
Mailing Address - Phone:951-698-3000
Mailing Address - Fax:951-698-7700
Practice Address - Street 1:25470 MEDICAL CENTER DR STE 203
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4901
Practice Address - Country:US
Practice Address - Phone:951-973-7290
Practice Address - Fax:951-973-7299
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136959208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery