Provider Demographics
NPI:1225076748
Name:NANDA, NITIN (MD)
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:
Last Name:NANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1793
Mailing Address - Country:US
Mailing Address - Phone:818-907-1480
Mailing Address - Fax:818-907-1481
Practice Address - Street 1:5000 VAN NUYS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1793
Practice Address - Country:US
Practice Address - Phone:818-907-1480
Practice Address - Fax:818-907-1481
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA563862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563862Medicaid
CA260044488OtherRAILROAD MEDICARE
CAG46426Medicare UPIN
CA00A563862Medicaid