Provider Demographics
NPI:1053391185
Name:BARSOUM, NOHA R (MD)
Entity type:Individual
Prefix:
First Name:NOHA
Middle Name:R
Last Name:BARSOUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5805 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2546
Mailing Address - Country:US
Mailing Address - Phone:818-908-8048
Mailing Address - Fax:818-908-8072
Practice Address - Street 1:12660 RIVERSIDE DR
Practice Address - Street 2:SUITE 225
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-3429
Practice Address - Country:US
Practice Address - Phone:818-487-0040
Practice Address - Fax:818-487-0050
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2008-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA64657207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A646570Medicaid
CA00A646570Medicaid
CAWA64657AMedicare PIN