Provider Demographics
NPI:1578370508
Name:MENTSOYAN, SIMA DIANA (FNP-C)
Entity type:Individual
Prefix:
First Name:SIMA
Middle Name:DIANA
Last Name:MENTSOYAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7349 BALBOA BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2781
Mailing Address - Country:US
Mailing Address - Phone:818-437-7379
Mailing Address - Fax:
Practice Address - Street 1:7349 BALBOA BLVD APT 3
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2781
Practice Address - Country:US
Practice Address - Phone:818-437-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily