Provider Demographics
NPI:1861523490
Name:FRED NOWROOZI, M. D., INC.
Entity type:Organization
Organization Name:FRED NOWROOZI, M. D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:NOWROOZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-223-7000
Mailing Address - Street 1:1501 N PLACENTIA AVE
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-2332
Mailing Address - Country:US
Mailing Address - Phone:714-223-7000
Mailing Address - Fax:714-223-7001
Practice Address - Street 1:1501 N PLACENTIA AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-2332
Practice Address - Country:US
Practice Address - Phone:714-223-7000
Practice Address - Fax:714-223-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA363802081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherFEDERAL TAX ID
CAW16024Medicare ID - Type Unspecified
CA=========OtherFEDERAL TAX ID