MEDICARE: IRINA AYRAPETYAN

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	363LP2300X	Primary Care Nurse Practitioner	95024820	CA

General Provider Information

NPI Number	:	1720837362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA AYRAPETYAN

Provider Business Mailing Address
First Line	:	6419 KRAFT AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-2624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5015 EAGLE ROCK BLVD STE 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90041-2087
Country	:	US
Telephone Number	:	747-300-7541
Fax Number	:	818-471-4287

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

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/25/2026

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