Mitra Tahvildarian, PH.D., AGNP, CFMP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

95003672 Issued in CA

Practice address

15840 Ventura Blvd
301
Encino, CA 91436-2932

Phone

(818) 917-2371

NPI assigned

Jan 25, 2016

Last updated

Mar 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Synergize Nursing Inc

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  • Encino, CA
  • NPI 1356803035
  Authorized official Same address or phone
• Honest Dermatology Medical Group

  dba Honest Dermatology Skin and Laser Center

  • Dermatology Physician
  • Encino, CA
  • NPI 1881935823
  NPD

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615161600000",
    "number": "1730546581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15840 VENTURA BLVD STE 301",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362932",
            "telephone_number": "818-917-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15840 VENTURA BLVD",
            "address_2": "301",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362932",
            "telephone_number": "818-917-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAHVILDARIAN",
        "first_name": "MITRA",
        "name_prefix": "Dr.",
        "credential": "PH.D., AGNP, CFMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-25",
        "last_updated": "2021-03-08",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95003672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mona Tabib, MD
• Armine Tadevosyan, FNP
• Samah Tadros
• Alisa Tagvoryan
• Hamid Reza Tahery, M.D.
• Tajav Toomari DO Inc
• Kaylee Takami
• Jacob Raul Talavera
• Talented People Inc
• Talin Amadian, OD, a Professional Corporation (Woodley Optometry)

• Gerontology Nurse Practitioner in Encino, CA
• Providers in Encino, CA by specialty
• Gerontology Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 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.