Healthcare Provider Details

I. General information

NPI: 1871388512
Provider Name (Legal Business Name): ELLEN OGANESYAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 E OLIVE AVE APT D
BURBANK CA
91501-2135
US

IV. Provider business mailing address

718 E OLIVE AVE APT D
BURBANK CA
91501-2135
US

V. Phone/Fax

Practice location:
  • Phone: 818-425-3154
  • Fax:
Mailing address:
  • Phone: 818-425-3154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95034589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: