MEDICARE: NELLI BERBERYAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP95018416	CA

General Provider Information

NPI Number	:	1083370936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELLI BERBERYAN NP

Provider Business Mailing Address
First Line	:	11856 BALBOA BLVD # 482
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-2753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14411 HAMLIN ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-1467
Country	:	US
Telephone Number	:	818-994-0616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/15/2021

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Directions to “ NELLI BERBERYAN NP” Practice Location

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