Provider Demographics
NPI:1821794975
Name:MINASSIAN, ELIN
Entity Type:Individual
Prefix:
First Name:ELIN
Middle Name:
Last Name:MINASSIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 W STOCKER ST APT 301
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2306
Mailing Address - Country:US
Mailing Address - Phone:818-220-7403
Mailing Address - Fax:
Practice Address - Street 1:14241 VENTURA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2742
Practice Address - Country:US
Practice Address - Phone:818-220-7403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024028163W00000X, 163WS0121X, 207N00000X, 207QA0505X, 207QG0300X, 207RH0002X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care