Healthcare Provider Details

I. General information

NPI: 1801683784
Provider Name (Legal Business Name): ELIZA SHAKHIKYAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE LL15
ENCINO CA
91436-4931
US

IV. Provider business mailing address

13443 STAGG ST
PANORAMA CITY CA
91402-6429
US

V. Phone/Fax

Practice location:
  • Phone: 818-905-1567
  • Fax:
Mailing address:
  • Phone: 213-377-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: