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NPI Code Detail

MEDICARE: MISS ELIZABETH MARATOVNA KHAVKINA PMHNP-BC

MEDICARE: MISS ELIZABETH MARATOVNA KHAVKINA PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95037175CA
2163W00000XRegistered Nurse95311194CA

General Provider Information

NPI Number : 1073376612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ELIZABETH MARATOVNA KHAVKINA PMHNP-BC
Provider Business Mailing Address
First Line : 11901 LOUISE AVE
Second Line :
City : GRANADA HILLS
State : CA
Zip : 91344-2449
Country : US
Telephone Number : 323-717-9626
Fax Number :
Provider Business Practice Location Address
First Line : 2900 E DEL MAR BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-4375
Country : US
Telephone Number : 626-795-9901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2024
Last Update Date : 03/04/2026

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Directions to “ MISS ELIZABETH MARATOVNA KHAVKINA PMHNP-BC” Practice Location

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