Provider Demographics
NPI:1568605236
Name:NADZHAFOV, MICHAEL (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NADZHAFOV
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11999 SAN VICENTE BLVD
Mailing Address - Street 2:#440
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5131
Mailing Address - Country:US
Mailing Address - Phone:310-471-5852
Mailing Address - Fax:310-472-9582
Practice Address - Street 1:1141 N BRAND BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2511
Practice Address - Country:US
Practice Address - Phone:818-546-1500
Practice Address - Fax:818-546-1501
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
19506363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical