Individual
MIRA TAKHALOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
8445 VERNON AVENUE #309, LOS ANGELES, CA 90067-4565
(323) 633-6363
Mailing address
1155 N GARDNER ST APT 302, WEST HOLLYWOOD, CA 90046-5623
(323) 509-8192
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
Primary
586479
CA
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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