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General NPI Number Information
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NPI Number | 1407354384
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Entity Type | Individual
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Provider Name | LINDA JOYCE TAKVORIAN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 714 N AVALON BLVD
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City | WILMINGTON
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State | CA
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Zip | 90744-5809
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Country | US
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Telephone | 310-522-4200
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Fax | 310-878-0230
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Provider Business Mailing Address
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Address Line | 215 BARBOUR ST
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7715
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Country | US
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Telephone | 310-306-2427
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Fax | 310-306-6427
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95008224
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License Number State | CA
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