# WATT AVENUE MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124218979
- **Authorized official:** DR. NOUROLLAH DANIALYPOUR M.D. (OWNER)
- **Authorized official phone:** (916) 344-8866

## Contact information

- **Practice address:** 5710 WATT AVE, NORTH HIGHLANDS, CA 95660-4752
- **Practice address phone:** (916) 344-8866
- **Practice address fax:** (916) 344-3979
- **Mailing address:** 5710 WATT AVE, NORTH HIGHLANDS, CA 95660-4752
- **Mailing address phone:** (916) 344-8866
- **Mailing address fax:** (916) 344-3979

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A41114 | CA | Yes |

## Other

- **Enumeration date:** 07/27/2007
- **Last updated:** 12/14/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1245304856 | INDIVIDUAL NPI | CA |
| 01 | — | GR0103750 | GROUP NUMBER | CA |