MEDICARE: MARYAM AHMADIAN N.P.

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	NP12577	CA

General Provider Information

NPI Number	:	1811909955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAM AHMADIAN N.P.

Provider Business Mailing Address
First Line	:	11620 WILSHIRE BLVD STE 102
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6801
Country	:	US
Telephone Number	:	310-385-3300
Fax Number	:	310-423-3794

Provider Business Practice Location Address
First Line	:	99 N LA CIENEGA BLVD STE 202
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2285
Country	:	US
Telephone Number	:	310-385-3300
Fax Number	:	310-385-3366

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/15/2025

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