Healthcare Provider Details

I. General information

NPI: 1124953252
Provider Name (Legal Business Name): MARIYA KHACHATURYAN MSN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N CENTRAL AVE APT 426
GLENDALE CA
91203-3352
US

IV. Provider business mailing address

540 N CENTRAL AVE APT 426
GLENDALE CA
91203-3352
US

V. Phone/Fax

Practice location:
  • Phone: 818-606-6869
  • Fax:
Mailing address:
  • Phone: 818-606-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: