MEDICARE: DR. JARED ALAN NISKA M.D.

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	207XS0106X	Orthopaedic Hand Surgery Physician	A115435	CA

General Provider Information

NPI Number	:	1427364579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JARED ALAN NISKA M.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24051 NEWHALL RANCH RD BLDG C
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91355-5702
Country	:	US
Telephone Number	:	661-254-6364
Fax Number	:

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

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	10/13/2022

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