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General NPI Number Information
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NPI Number | 1386706406
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Entity Type | Individual
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Provider Name | NICOLE NOUSHIN MASSARAT PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 323-857-2894
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Fax |
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Provider Business Mailing Address
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Address Line | 107 WINNETT PL
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City | SANTA MONICA
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State | CA
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Zip | 90402-2009
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Country | US
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Telephone | 310-458-2832
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 45209
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License Number State | CA
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