Provider Demographics
NPI:1164831368
Name:IRIAS, DAVID ANTONIO (RN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTONIO
Last Name:IRIAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1236
Mailing Address - Country:US
Mailing Address - Phone:323-286-8723
Mailing Address - Fax:
Practice Address - Street 1:1366 W 38TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1236
Practice Address - Country:US
Practice Address - Phone:323-286-8723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95143251163WP0808X, 163WA0400X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical