Provider Demographics
NPI:1538493259
Name:STARK, NIRA
Entity Type:Individual
Prefix:
First Name:NIRA
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIRA
Other - Middle Name:
Other - Last Name:KVART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1477 S CANFIELD AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3272
Mailing Address - Country:US
Mailing Address - Phone:323-397-6552
Mailing Address - Fax:
Practice Address - Street 1:1477 S CANFIELD AVE APT 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3272
Practice Address - Country:US
Practice Address - Phone:323-397-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker