MEDICARE: OLIVIA NASSOIY

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
1	367500000X	Certified Registered Nurse Anesthetist	95001451	CA

General Provider Information

NPI Number	:	1114523305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA NASSOIY

Provider Business Mailing Address
First Line	:	1717 ROBSON AVE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5917
Country	:	US
Telephone Number	:	847-912-2664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 ROBSON AVE
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5917
Country	:	US
Telephone Number	:	847-912-2664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	12/11/2020

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Directions to “ OLIVIA NASSOIY ” Practice Location

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