Active NPI
Rose Nikravesh, D.O.
- Psychiatry Physician
- Los Angeles, CA
National Provider Identifier
1720222847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 20A 12932
- Practice address
- 5105 W Goldleaf Cir
Los Angeles, CA 90056-1269 - Phone
- (323) 298-3100
- NPI assigned
- Apr 21, 2009
- Last updated
- Apr 8, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 20A 12932 | CA | Primary |
Addresses
Primary practice location
5105 W Goldleaf Cir
Los Angeles, CA 90056-1269
Mailing address
5105 W Goldleaf Cir
Los Angeles, CA 90056-1269
Phone (323) 298-3100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 2, 2025 through May 2, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A 12932 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428451200000",
"number": "1720222847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5105 W GOLDLEAF CIR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900561269",
"telephone_number": "323-298-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5105 W GOLDLEAF CIR",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900561269",
"telephone_number": "323-298-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIKRAVESH",
"first_name": "ROSE",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-21",
"last_updated": "2015-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "20A 12932",
"primary": true
}
],
"identifiers": [],
"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 Apr 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.