Healthcare Provider Details

I. General information

NPI: 1104666114
Provider Name (Legal Business Name): THE NEST LOS ANGELES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11425 MOORPARK ST
STUDIO CITY CA
91602-2009
US

IV. Provider business mailing address

11425 MOORPARK ST
STUDIO CITY CA
91602-2009
US

V. Phone/Fax

Practice location:
  • Phone: 310-920-8544
  • Fax: 888-420-6257
Mailing address:
  • Phone: 310-920-8544
  • Fax: 888-420-6257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DIANA FUNK
Title or Position: ADMINISTRATON
Credential:
Phone: 949-422-3609