Provider Demographics
NPI:1326535105
Name:CARVAJAL, NINIA R (NP)
Entity Type:Individual
Prefix:
First Name:NINIA
Middle Name:R
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W LEXINGTON DR STE 303B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2203
Mailing Address - Country:US
Mailing Address - Phone:626-274-5411
Mailing Address - Fax:818-671-5581
Practice Address - Street 1:121 W LEXINGTON DR STE 303B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2203
Practice Address - Country:US
Practice Address - Phone:818-671-0012
Practice Address - Fax:818-671-5581
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006625363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner