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NPI Code Detail

MEDICARE: EMANOUEL KHODADADI MSN-FNP-BC

MEDICARE: EMANOUEL KHODADADI MSN-FNP-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
1363LF0000XFamily Nurse PractitionerNP95032782CA

General Provider Information

NPI Number : 1477347193
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMANOUEL KHODADADI MSN-FNP-BC
Provider Business Mailing Address
First Line : 1818 VERDUGO BLVD STE 401
Second Line :
City : GLENDALE
State : CA
Zip : 91208-1421
Country : US
Telephone Number : 818-790-1145
Fax Number : 818-790-6387
Provider Business Practice Location Address
First Line : 1818 VERDUGO BLVD STE 401
Second Line :
City : GLENDALE
State : CA
Zip : 91208-1421
Country : US
Telephone Number : 818-790-1145
Fax Number : 818-790-6387
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2025
Last Update Date : 04/07/2025

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