Healthcare Provider Details

I. General information

NPI: 1386693208
Provider Name (Legal Business Name): PIA NERIA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR #105
GLENDALE CA
91205-4431
US

IV. Provider business mailing address

801 S CHEVY CHASE DR #20
GLENDALE CA
91205-4431
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-5299
  • Fax: 818-637-7607
Mailing address:
  • Phone: 818-265-2237
  • Fax: 818-265-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: