MEDICARE: NINO MAILOV

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	NP95039133	CA

General Provider Information

NPI Number	:	1669305744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINO MAILOV

Provider Business Mailing Address
First Line	:	1505 WILSON TER
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4071
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 WILSON TER
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4071
Country	:	US
Telephone Number	:	818-409-8000
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ NINO MAILOV ” Practice Location

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