Healthcare Provider Details

I. General information

NPI: 1104760677
Provider Name (Legal Business Name): LOIDA MANSOURIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W GLENOAKS BLVD
GLENDALE CA
91202-2916
US

IV. Provider business mailing address

6348 N MILWAUKEE AVE STE 390
CHICAGO IL
60646-3728
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-4300
  • Fax:
Mailing address:
  • Phone: 847-235-6130
  • Fax: 847-235-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95039051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: