Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 N 11TH ST STE 104
FRESNO CA
93720-3375
US

IV. Provider business mailing address

4411 E KINGS CANYON RD
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-0800
  • Fax:
Mailing address:
  • Phone: 559-538-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number810144
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95007085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: