Healthcare Provider Details

I. General information

NPI: 1427845783
Provider Name (Legal Business Name): DIANA GEVORGYAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 W GLENOAKS BLVD STE B
GLENDALE CA
91201-4746
US

IV. Provider business mailing address

1911 W GLENOAKS BLVD STE B
GLENDALE CA
91201-4746
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-6640
  • Fax: 818-843-0347
Mailing address:
  • Phone: 818-843-6640
  • Fax: 818-843-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: