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General NPI Number Information
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NPI Number | 1508088238
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Entity Type | Individual
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Provider Name | MARGO MINISSIAN ACNP, APRN-BC, MSN,
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 444 S SAN VICENTE BLVD SUITE 600
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City | LOS ANGELES
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State | CA
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Zip | 90048-4165
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Country | US
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Telephone | 310-423-9977
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Fax | 310-423-9681
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Provider Business Mailing Address
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Address Line | 1174 DEL REY AVE
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City | PASADENA
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State | CA
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Zip | 91107-1811
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Country | US
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Telephone | 310-384-0126
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 15841
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License Number State | CA
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