Healthcare Provider Details

I. General information

NPI: 1730042771
Provider Name (Legal Business Name): LENA DERKRIKORIAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 AUSTRALIA ST
EL CAJON CA
92020-8806
US

IV. Provider business mailing address

1257 AUSTRALIA ST
EL CAJON CA
92020-8806
US

V. Phone/Fax

Practice location:
  • Phone: 301-928-9976
  • Fax:
Mailing address:
  • Phone: 301-928-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number95103160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: