Healthcare Provider Details

I. General information

NPI: 1083429039
Provider Name (Legal Business Name): LEONAR HOVSEPIAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N ORANGE ST STE G
GLENDALE CA
91203-2655
US

IV. Provider business mailing address

213 N ORANGE ST STE G
GLENDALE CA
91203-2655
US

V. Phone/Fax

Practice location:
  • Phone: 818-855-1573
  • Fax: 818-855-1509
Mailing address:
  • Phone: 818-855-1573
  • Fax: 818-855-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: