MEDICARE: DAVID ANTONIO IRIAS APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP70097249	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95039103	CA

General Provider Information

NPI Number	:	1164831368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ANTONIO IRIAS APRN

Provider Business Mailing Address
First Line	:	4011 W JEFFERSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4122
Country	:	US
Telephone Number	:	323-860-4491
Fax Number	:

Provider Business Practice Location Address
First Line	:	4011 W JEFFERSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-4122
Country	:	US
Telephone Number	:	323-286-8723
Fax Number	:

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

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	03/25/2026

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