Healthcare Provider Details

I. General information

NPI: 1801051248
Provider Name (Legal Business Name): NEEVON CARL ESMAILI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 W OLYMPIC BLVD STE 660
LOS ANGELES CA
90064-1679
US

IV. Provider business mailing address

PO BOX 5509
SHERMAN OAKS CA
91413-5509
US

V. Phone/Fax

Practice location:
  • Phone: 310-935-0032
  • Fax: 310-935-0042
Mailing address:
  • Phone: 510-418-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number66447
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number8727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: