Healthcare Provider Details

I. General information

NPI: 1730777467
Provider Name (Legal Business Name): ELMA HACOPIAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S GLENOAKS BLVD
BURBANK CA
91502-1448
US

IV. Provider business mailing address

401 S GLENOAKS BLVD
BURBANK CA
91502-1448
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: