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General NPI Number Information
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NPI Number | 1104760677
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Entity Type | Individual
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Provider Name | LOIDA MANSOURIAN NP
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Gender | Female
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 409 W GLENOAKS BLVD
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City | GLENDALE
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State | CA
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Zip | 91202-2916
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Country | US
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Telephone | 818-240-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 6348 N MILWAUKEE AVE STE 390
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City | CHICAGO
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State | IL
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Zip | 60646-3728
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Country | US
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Telephone | 847-235-6130
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Fax | 847-235-6135
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP95039051
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License Number State | CA
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