Healthcare Provider Details

I. General information

NPI: 1063238392
Provider Name (Legal Business Name): DANICA NEVART TASHJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL STE 410
PASADENA CA
91105-3175
US

IV. Provider business mailing address

50 ALESSANDRO PL STE 410
PASADENA CA
91105-3175
US

V. Phone/Fax

Practice location:
  • Phone: 626-659-5418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number66186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: