MEDICARE: ARYAN JAMALI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95012187	CA
2	251E00000X	Home Health Agency	95012187	CA

General Provider Information

NPI Number	:	1013553858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARYAN JAMALI

Provider Business Mailing Address
First Line	:	30423 CANWOOD ST STE 225
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4367
Country	:	US
Telephone Number	:	818-871-9518
Fax Number	:	818-871-9521

Provider Business Practice Location Address
First Line	:	30423 CANWOOD ST STE 225
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4367
Country	:	US
Telephone Number	:	818-871-9518
Fax Number	:	818-871-9521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	06/20/2022

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