=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558124867
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIANA SULT PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2024
-----------------------------------------------------
Last Update Date | 11/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6320 CANOGA AVE STE 1500
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-2517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-746-4720
-----------------------------------------------------
Fax | 747-204-3104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6320 CANOGA AVE STE 1500
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-2517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-746-4720
-----------------------------------------------------
Fax | 747-204-3104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | NP95028901
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------