Healthcare Provider Details

I. General information

NPI: 1295644029
Provider Name (Legal Business Name): LAUREN ELLEN NIVICHANOV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24440 TREASURE VISTA AVE
NEWHALL CA
91321-3525
US

IV. Provider business mailing address

24440 TREASURE VISTA AVE
NEWHALL CA
91321-3525
US

V. Phone/Fax

Practice location:
  • Phone: 661-607-4550
  • Fax:
Mailing address:
  • Phone: 661-607-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360832
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: