NPIMap

Organization Active NPI

Chrysalis Health of California, PC

  • Endocrinology, Diabetes & Metabolism Physician
  • Los Angeles, CA
National Provider Identifier
1407324379
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
CHRYSALIS HEALTH OF CALIFORNIA, PC
Practice address
4470 W Sunset Blvd # 92709
Los Angeles, CA 90027-6302
Phone
(424) 334-9213
NPI assigned
Nov 8, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Authorized official

Name
Marina Tarasova
Title
Coo
Phone
(847) 809-6796

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X Primary

Addresses

Primary practice location

4470 W Sunset Blvd # 92709
Los Angeles, CA 90027-6302

Mailing address

136 E 76TH St Apt 8F
New York, NY 10021-2831
Phone (434) 248-7508

Other identifiers 1

IdentifierTypeStateIssuer
1104823954MedicaidCA

National Provider Directory

National Provider Directory

Locations

4470 W Sunset Blvd
#92709
Los Angeles, CA 90027
Phone (424) 334-9213

9255 Kingston Pike
Knoxville, TN 37922

Practitioners & affiliated clinicians

Practitioners 5

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": "1541635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611273600000",
    "number": "1407324379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 E 76TH ST APT 8F",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100212831",
            "telephone_number": "434-248-7508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4470 W SUNSET BLVD # 92709",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276302",
            "telephone_number": "424-334-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRYSALIS HEALTH OF CALIFORNIA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-08",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A",
        "authorized_official_last_name": "TARASOVA",
        "authorized_official_first_name": "MARINA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "847-809-6796"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104823954",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.