Nina M Siregar, FNP
Nurse Practitioner in Los Angeles, CA. Individual provider (NPI-1).
NPI number1104547686
StatusActive
Last updated in NPPESSep 5, 2022
Details
- NPI
- 1104547686
- Entity type
- Individual (NPI-1)
- Name
- Nina M Siregar
- Credential
- FNP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 5, 2022
- Certification date
- Sep 3, 2022
- Last updated
- Sep 5, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 95020220 | CA | Yes |
Practice location
808 W 58th StLos Angeles, CA 90037-3632
Phone 323-541-1600
Mailing address
808 W 58th StLos Angeles, CA 90037-3632
Phone 323-541-1600
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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