MEDICARE: NASTARAN MINASSIANS NP

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	164W00000X	Licensed Practical Nurse	12793	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	W11698	OTHER	CA	GROUP ID

General Provider Information

NPI Number	:	1679741425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NASTARAN MINASSIANS NP

Provider Business Mailing Address
First Line	:	15206 PARTHENIA ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-5305
Country	:	US
Telephone Number	:	818-895-3100
Fax Number	:	818-892-3352

Provider Business Practice Location Address
First Line	:	4842 HOLLYWOOD BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5302
Country	:	US
Telephone Number	:	323-644-1118
Fax Number	:	323-644-1171

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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