Healthcare Provider Details

I. General information

NPI: 1932964970
Provider Name (Legal Business Name): SERZH BOYNAGIRYAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 S GLENDALE AVE STE 201
GLENDALE CA
91205-3388
US

IV. Provider business mailing address

1241 S GLENDALE AVE STE 201
GLENDALE CA
91205-3388
US

V. Phone/Fax

Practice location:
  • Phone: 424-489-1537
  • Fax: 818-500-0509
Mailing address:
  • Phone: 424-489-1537
  • Fax: 818-500-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95273871
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95028967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: