Healthcare Provider Details

I. General information

NPI: 1033059605
Provider Name (Legal Business Name): KREMENA DIMITROVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S ARDMORE AVE APT 341
LOS ANGELES CA
90020-3308
US

IV. Provider business mailing address

525 S ARDMORE AVE APT 341
LOS ANGELES CA
90020-3308
US

V. Phone/Fax

Practice location:
  • Phone: 310-467-7623
  • Fax:
Mailing address:
  • Phone: 310-467-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: