Healthcare Provider Details

I. General information

NPI: 1821794975
Provider Name (Legal Business Name): ELIN MINASSIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N ROXBURY DR STE 115
BEVERLY HILLS CA
90210-5016
US

IV. Provider business mailing address

439 W STOCKER ST APT 301
GLENDALE CA
91202-2306
US

V. Phone/Fax

Practice location:
  • Phone: 818-220-7403
  • Fax:
Mailing address:
  • Phone: 818-220-7403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95024028
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95024028
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95024028
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number95024028
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number95024028
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number95024028
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number95024028
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number95024028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: