Healthcare Provider Details

I. General information

NPI: 1992697940
Provider Name (Legal Business Name): STELLA KHECHUMYAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N GLENOAKS BLVD STE 200
BURBANK CA
91502-1118
US

IV. Provider business mailing address

303 N GLENOAKS BLVD STE 200
BURBANK CA
91502-1118
US

V. Phone/Fax

Practice location:
  • Phone: 818-306-7375
  • Fax:
Mailing address:
  • Phone: 818-306-7375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF05250111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: