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Organization
WATT AVENUE MEDICAL CLINIC
Active
Organization
WATT AVENUE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NOUROLLAH DANIALYPOUR M.D. (OWNER)
(916) 344-8866
Entity
Organization
Contact information
Practice address
5710 WATT AVE, NORTH HIGHLANDS, CA 95660-4752
(916) 344-8866
(916) 344-3979
Mailing address
5710 WATT AVE, NORTH HIGHLANDS, CA 95660-4752
(916) 344-8866
(916) 344-3979
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A41114
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245304856
INDIVIDUAL NPI
CA
01
—
GR0103750
GROUP NUMBER
CA
Enumeration date
07/27/2007
Last updated
12/14/2010
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