Provider Demographics
NPI:1750340246
Name:HANISS-YOUSSEF, NIRMEEN (PA-C)
Entity type:Individual
Prefix:
First Name:NIRMEEN
Middle Name:
Last Name:HANISS-YOUSSEF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-248-6679
Mailing Address - Fax:310-423-6795
Practice Address - Street 1:127 S SAN VICENTE BLVD STE A3600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3311
Practice Address - Country:US
Practice Address - Phone:310-248-6679
Practice Address - Fax:310-423-6795
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP72958Medicare UPIN