Healthcare Provider Details

I. General information

NPI: 1932046729
Provider Name (Legal Business Name): VIKTOR FANARJYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N CENTRAL AVE STE 103
GLENDALE CA
91203-3555
US

IV. Provider business mailing address

229 N CENTRAL AVE STE 103
GLENDALE CA
91203-3555
US

V. Phone/Fax

Practice location:
  • Phone: 818-813-8888
  • Fax: 747-777-4022
Mailing address:
  • Phone: 818-813-8888
  • Fax: 747-777-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: