Healthcare Provider Details

I. General information

NPI: 1518748458
Provider Name (Legal Business Name): DIANA MELKUMYAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 01/04/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 N VERDUGO RD STE 108
GLENDALE CA
91208-2858
US

IV. Provider business mailing address

255 E ORANGE GROVE AVE STE D
BURBANK CA
91502-1240
US

V. Phone/Fax

Practice location:
  • Phone: 747-215-6714
  • Fax: 747-215-2372
Mailing address:
  • Phone: 747-262-1155
  • Fax: 747-262-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95027412
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: