=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982561148
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MANNANA NAIRI TAMAZYAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2026
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4143 VERDUGO RD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90065-3820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-844-2006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9063 RIDERWOOD DR
-----------------------------------------------------
City | SUNLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91040-2628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-531-5910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 95038162
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------