Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | DC30885 | CA |
N | 111NN1001X | Nutrition | DC30885 | CA |
NPI | 1053571752 |
---|---|
Provider Name | Dr. Mohamad Baktash Noori |
First Address | Mission Veijo, CA 92691 |
Second Address | Mission Viejo, CA 92691-1238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 16/06/2008 |