Basic Information
| Provider Information | |||||||||
| NPI: | 1457885360 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BITA NOORANBAKHT MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3225 N 75TH ST | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807185986 | ||||||||
| FaxNumber: | 4809472494 | ||||||||
| Practice Location | |||||||||
| Address1: | 3225 N 75TH ST | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852516909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807185986 | ||||||||
| FaxNumber: | 4809472494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2017 | ||||||||
| LastUpdateDate: | 04/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | NOORANBAKHT | ||||||||
| AuthorizedOfficialFirstName: | BITA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4807185986 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M,D, | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 30670 | AZ | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.