Healthcare Provider Details

I. General information

NPI: 1316393820
Provider Name (Legal Business Name): ANNA MEZENTSEVA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13754 VICTORY BLVD
VAN NUYS CA
91401-2324
US

IV. Provider business mailing address

13754 VICTORY BLVD
VAN NUYS CA
91401-2324
US

V. Phone/Fax

Practice location:
  • Phone: 818-616-1373
  • Fax: 818-616-1384
Mailing address:
  • Phone: 818-616-1373
  • Fax: 818-616-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: