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NPI 1568385334 Active Nurse Practitioner, Pediatrics

Quick Facts

NPI Number

1568385334

Type

Individual (NPI-1)

Status

Active

Enumeration Date

2026-07-30

Last Updated (NPPES)

2026-07-30

Primary Specialty / Taxonomy

Taxonomy	Nurse Practitioner, Pediatrics
Taxonomy Code	`363LP0200X`
License	95040567 CA

Practice Address

4650 W SUNSET BLVD
LOS ANGELES, CA 900276062

Phone: 323-660-2450

Mailing Address

1027 W ANGELENO AVE APT 111
BURBANK, CA 915063419

Data sourced live from the CMS NPPES NPI Registry (npiregistry.cms.hhs.gov) and cached locally. This is a public directory lookup, not a credentialing or verification service — confirm critical details directly with NPPES or the provider.