Provider Demographics
NPI:1396995833
Name:GANEZER, EMILIYA SHAPIRO (NP)
Entity type:Individual
Prefix:
First Name:EMILIYA
Middle Name:SHAPIRO
Last Name:GANEZER
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 1:9400 BRIGHTON WAY
Mailing Address - Street 2:STE 410
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4711
Mailing Address - Country:US
Mailing Address - Phone:323-588-2004
Mailing Address - Fax:
Practice Address - Street 1:24013 VENTURA BLVD
Practice Address - Street 2:101
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1094
Practice Address - Country:US
Practice Address - Phone:818-222-2443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2017-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505125, 17591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily