Healthcare Provider Details

I. General information

NPI: 1679741425
Provider Name (Legal Business Name): NASTARAN MINASSIANS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4842 HOLLYWOOD BLVD
LOS ANGELES CA
90027-5302
US

IV. Provider business mailing address

15206 PARTHENIA ST
NORTH HILLS CA
91343-5305
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-1118
  • Fax: 323-644-1171
Mailing address:
  • Phone: 818-895-3100
  • Fax: 818-892-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number12793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: