Healthcare Provider Details

I. General information

NPI: 1710670641
Provider Name (Legal Business Name): GINNEY MARY BELADJIAN MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WILSON TER STE 340
GLENDALE CA
91206-4072
US

IV. Provider business mailing address

1505 WILSON TER STE 340
GLENDALE CA
91206-4072
US

V. Phone/Fax

Practice location:
  • Phone: 818-543-7574
  • Fax: 818-956-7609
Mailing address:
  • Phone: 818-543-7574
  • Fax: 818-956-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95025345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: