Provider Demographics
NPI:1467733360
Name:ZADEH, NERA ISMAIL (NP)
Entity Type:Individual
Prefix:
First Name:NERA
Middle Name:ISMAIL
Last Name:ZADEH
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 1:2855 WASATCH CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3749
Mailing Address - Country:US
Mailing Address - Phone:818-404-2544
Mailing Address - Fax:
Practice Address - Street 1:4835 VAN NUYS BLVD STE 109
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2134
Practice Address - Country:US
Practice Address - Phone:818-784-3615
Practice Address - Fax:818-905-0130
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598798163W00000X
CA17605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse