Basic Information
Provider Information
NPI: 1649666041
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NOROUZI
FirstName: SAYNA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11234 ANDERSON ST # MC-1516
Address2:  
City: LOMA LINDA
State: CA
PostalCode: 923542804
CountryCode: US
TelephoneNumber: 9095584499
FaxNumber: 9095580428
Practice Location
Address1: 11234 ANDERSON ST # MC1516
Address2:  
City: LOMA LINDA
State: CA
PostalCode: 923542804
CountryCode: US
TelephoneNumber: 9095584499
FaxNumber: 9095580428
Other Information
ProviderEnumerationDate: 04/13/2015
LastUpdateDate: 11/02/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300XA167931CAY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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