Healthcare Provider Details

I. General information

NPI: 1528599982
Provider Name (Legal Business Name): ANDRANIK AVAKIAN PMHNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W BULLARD AVE STE 101
CLOVIS CA
93612-0861
US

IV. Provider business mailing address

2204 E RUSH AVE
FRESNO CA
93730-4715
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-2435
  • Fax:
Mailing address:
  • Phone: 559-709-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95007085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: