Healthcare Provider Details

I. General information

NPI: 1467733360
Provider Name (Legal Business Name): NERA ISMAIL ZADEH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 08/08/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 VAN NUYS BLVD STE 109
SHERMAN OAKS CA
91403-2134
US

IV. Provider business mailing address

2855 WASATCH CT
WESTLAKE VILLAGE CA
91362-3749
US

V. Phone/Fax

Practice location:
  • Phone: 818-784-3615
  • Fax: 818-905-0130
Mailing address:
  • Phone: 818-404-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17605
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number598798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: