Provider Demographics
NPI:1912983818
Name:NOROUZI, BRIAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:B
Last Name:NOROUZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2626
Mailing Address - Country:US
Mailing Address - Phone:714-547-5741
Mailing Address - Fax:714-547-5078
Practice Address - Street 1:1801 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2626
Practice Address - Country:US
Practice Address - Phone:714-547-5741
Practice Address - Fax:714-547-5078
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78215208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G782150Medicaid
CAG78215OtherBLUE CROSS
340019087OtherRAILROAD MEDICARE
CA00G782153OtherBLUE SHIELD
CAG78215OtherBLUE CROSS
CA00G782153OtherBLUE SHIELD