Healthcare Provider Details

I. General information

NPI: 1477191070
Provider Name (Legal Business Name): KNARIK OGANESYAN FNP PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S CENTRAL AVE STE 240
GLENDALE CA
91204-4645
US

IV. Provider business mailing address

710 S CENTRAL AVE STE 240
GLENDALE CA
91204-4645
US

V. Phone/Fax

Practice location:
  • Phone: 747-777-7047
  • Fax:
Mailing address:
  • Phone: 747-777-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013487
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95013487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: