Healthcare Provider Details

I. General information

NPI: 1871000802
Provider Name (Legal Business Name): TALIA NAHID AMIRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E HARDY ST
INGLEWOOD CA
90301-4011
US

IV. Provider business mailing address

110 S SWALL DR APT 301
LOS ANGELES CA
90048-3053
US

V. Phone/Fax

Practice location:
  • Phone: 310-673-4660
  • Fax:
Mailing address:
  • Phone: 310-487-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95007099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: