MEDICARE: MOHAMMAD IMTIAZ HUSSAIN RN, 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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP95025749	CA

General Provider Information

NPI Number	:	1245913441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD IMTIAZ HUSSAIN RN, PMHNP-BC

Provider Business Mailing Address
First Line	:	1335 3/4 N EDGEMONT ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5911
Country	:	US
Telephone Number	:	213-361-2636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 3/4 N EDGEMONT ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5911
Country	:	US
Telephone Number	:	213-361-2636
Fax Number	:

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

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	02/20/2026

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