Healthcare Provider Details

I. General information

NPI: 1447978721
Provider Name (Legal Business Name): ANI GEGHAMYAN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E COLORADO ST STE 420
GLENDALE CA
91205-5123
US

IV. Provider business mailing address

425 E COLORADO ST STE 420
GLENDALE CA
91205-5123
US

V. Phone/Fax

Practice location:
  • Phone: 818-502-1341
  • Fax: 909-494-7649
Mailing address:
  • Phone: 818-502-1341
  • Fax: 909-494-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95123684
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017032
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: