Healthcare Provider Details

I. General information

NPI: 1780371005
Provider Name (Legal Business Name): NEPHROLOGY AND HYPERTENSION CONSULTANTS BURBANK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 W MAGNOLIA BLVD STE 210
BURBANK CA
91506-1771
US

IV. Provider business mailing address

5682 HOLLY OAK DR
LOS ANGELES CA
90068-2522
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-5595
  • Fax: 818-848-5749
Mailing address:
  • Phone: 818-848-5595
  • Fax: 818-848-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA MIKOYAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-848-5595