Healthcare Provider Details

I. General information

NPI: 1811909955
Provider Name (Legal Business Name): MARYAM AHMADIAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N LA CIENEGA BLVD STE 202
BEVERLY HILLS CA
90211-2285
US

IV. Provider business mailing address

11620 WILSHIRE BLVD STE 102
LOS ANGELES CA
90025-6801
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-3300
  • Fax: 310-385-3366
Mailing address:
  • Phone: 310-385-3300
  • Fax: 310-423-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberNP12577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: