Provider Demographics
NPI:1881925519
Name:NOUR, CHELAN ASHLEY (MD)
Entity type:Individual
Prefix:DR
First Name:CHELAN
Middle Name:ASHLEY
Last Name:NOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHELAN
Other - Middle Name:ASHLEY
Other - Last Name:MALMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1509 MARION RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6332
Mailing Address - Country:US
Mailing Address - Phone:310-701-6876
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:310-701-6876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114616207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology