Provider Demographics
NPI:1801051248
Name:ESMAILI, NEEVON CARL (MD)
Entity type:Individual
Prefix:
First Name:NEEVON
Middle Name:CARL
Last Name:ESMAILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5509
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-5509
Mailing Address - Country:US
Mailing Address - Phone:510-418-7047
Mailing Address - Fax:
Practice Address - Street 1:11400 W OLYMPIC BLVD STE 660
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1679
Practice Address - Country:US
Practice Address - Phone:310-935-0032
Practice Address - Fax:310-935-0042
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87272084P0804X
CA664472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry