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General NPI Number Information
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NPI Number | 1386350775
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Entity Type | Individual
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Provider Name | ANTHONY MORADIAN
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Gender | Male
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 4211 AVALON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90011-5622
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Country | US
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Telephone | 323-233-0425
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Fax |
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Provider Business Mailing Address
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Address Line | 10508 SUNLAND BLVD UNIT 4
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City | SUNLAND
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State | CA
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Zip | 91040-1941
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Country | US
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Telephone | 818-640-7513
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Fax |
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 95217062
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 95217062
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95023929
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95023929
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License Number State | CA
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