Healthcare Provider Details

I. General information

NPI: 1023969227
Provider Name (Legal Business Name): MARIAM KHALATIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N CAMDEN DR STE 950
BEVERLY HILLS CA
90210-1913
US

IV. Provider business mailing address

10656 ALDEA AVE
GRANADA HILLS CA
91344-6133
US

V. Phone/Fax

Practice location:
  • Phone: 424-377-2220
  • Fax: 424-600-8273
Mailing address:
  • Phone: 818-434-4374
  • Fax: 818-434-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: