Provider Demographics
NPI:1962145763
Name:NILE HEALTH OF CALIFORNIA, P.C.
Entity type:Organization
Organization Name:NILE HEALTH OF CALIFORNIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-689-9107
Mailing Address - Street 1:15260 VENTURA BLVD STE 1410
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5348
Mailing Address - Country:US
Mailing Address - Phone:818-456-0554
Mailing Address - Fax:
Practice Address - Street 1:15260 VENTURA BLVD STE 1410
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5348
Practice Address - Country:US
Practice Address - Phone:818-456-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsyGroup - Single Specialty