Healthcare Provider Details

I. General information

NPI: 1598829434
Provider Name (Legal Business Name): KRISTINA KARAPETYAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S. GLENOALS BLVD SUITE 101
BURBANK CA
91502-1911
US

IV. Provider business mailing address

519 E BROADWAY
GLENDALE CA
91205-1110
US

V. Phone/Fax

Practice location:
  • Phone: 818-748-1740
  • Fax: 818-748-1741
Mailing address:
  • Phone: 818-291-9747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: