Healthcare Provider Details

I. General information

NPI: 1780327791
Provider Name (Legal Business Name): ROMINA ISKANDARYAN MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 05/10/2024
Certification Date: 12/22/2023
Deactivation Date: 12/14/2023
Reactivation Date: 12/22/2023

III. Provider practice location address

14411 HAMLIN ST
VAN NUYS CA
91401-1467
US

IV. Provider business mailing address

14411 HAMLIN ST
VAN NUYS CA
91401-1467
US

V. Phone/Fax

Practice location:
  • Phone: 818-994-0616
  • Fax:
Mailing address:
  • Phone: 310-940-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95268848
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: