Basic Information
| Provider Information | |||||||||
| NPI: | 1013079557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATIA | ||||||||
| FirstName: | NISHA | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10025 LUBAS AVE | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187399637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14445 OLIVE WAY DR | ||||||||
| Address2: | OLIVE VIEW UCLA | ||||||||
| City: | SYLMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183643632 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | #10395 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | NP 10395 | 01 | CA | PROVIDER LICENSE | OTHER |