=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114868296
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNIE KAZAROVA FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2026
-----------------------------------------------------
Last Update Date | 04/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 E OLIVE AVE STE 750
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91501-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-244-4114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10025 SULLY DR
-----------------------------------------------------
City | SUN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91352-4270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-369-4347
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95039127
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------