Provider Demographics
NPI:1811571953
Name:NAZARIAN, ANDREA MELISSA (POSTDOCTORAL STUDENT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MELISSA
Last Name:NAZARIAN
Suffix:
Gender:F
Credentials:POSTDOCTORAL STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8938 TOBIAS AVE APT 315
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-1767
Mailing Address - Country:US
Mailing Address - Phone:818-726-0287
Mailing Address - Fax:
Practice Address - Street 1:18646 OXNARD ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1486
Practice Address - Country:US
Practice Address - Phone:818-654-3908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty