Organization Active NPI

Nu Vela Esthetica, Inc.

  • Plastic Surgery Physician
  • Porter Ranch, CA
National Provider Identifier
1013931591
Registry record updated Jun 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
A47717 Issued in CA
Legal business name
NU VELA ESTHETICA, INC.
Practice address
11200 Corbin Ave
Ste.# 104
Porter Ranch, CA 91326-4120
Phone
(818) 832-4500
Fax
(818) 832-4522
NPI assigned
Jul 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Raffi Dishakjian, M.D.NPI 1073538708
Title
President/Owner
Phone
(818) 888-7815

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X A47717 CA
Plastic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208200000X A47717 CA Primary

Addresses

Primary practice location

11200 Corbin Ave
Ste.# 104
Porter Ranch, CA 91326-4120

Mailing address

PO Box 7001
Tarzana, CA 91357-7001
Phone (818) 888-7815

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061101000530 CA Part B Supplier - Clinic/Group Practice 9335146463 Receives reassigned benefits from 1 practitioner
Practice locations: Porter Ranch, CA

National Provider Directory

National Provider Directory

Locations

11200 Corbin Ave
Ste 104
Porter Ranch, CA 91326
Phone (818) 832-4500

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433116800000",
    "number": "1013931591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7001",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913577001",
            "telephone_number": "818-888-7815",
            "fax_number": "818-715-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 CORBIN AVE",
            "address_2": "STE.# 104",
            "city": "PORTER RANCH",
            "state": "CA",
            "postal_code": "913264120",
            "telephone_number": "818-832-4500",
            "fax_number": "818-832-4522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NU VELA ESTHETICA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2015-06-01",
        "status": "A",
        "authorized_official_last_name": "DISHAKJIAN",
        "authorized_official_first_name": "RAFFI",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "818-888-7815",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A47717",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A47717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Porter Ranch, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.