Provider Demographics
NPI:1932520079
Name:ABBASI, MEHVISH (NP)
Entity Type:Individual
Prefix:
First Name:MEHVISH
Middle Name:
Last Name:ABBASI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEHVISH
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18433 ROSCOE BLVD
Mailing Address - Street 2:#102
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4108
Mailing Address - Country:US
Mailing Address - Phone:818-361-5437
Mailing Address - Fax:
Practice Address - Street 1:18433 ROSCOE BLVD
Practice Address - Street 2:#106
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4108
Practice Address - Country:US
Practice Address - Phone:818-361-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA729698363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics