MEDICARE: MIHAELA GUEORGUIEVA MIHAYLOVA

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	363L00000X	Nurse Practitioner	95031462	CA

General Provider Information

NPI Number	:	1245044577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIHAELA GUEORGUIEVA MIHAYLOVA

Provider Business Mailing Address
First Line	:	6131 VERA ST
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3746
Country	:	US
Telephone Number	:	818-437-1492
Fax Number	:

Provider Business Practice Location Address
First Line	:	5805 SEPULVEDA BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91411-2546
Country	:	US
Telephone Number	:	818-900-6480
Fax Number	:

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

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	02/06/2025

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