Healthcare Provider Details

I. General information

NPI: 1770314908
Provider Name (Legal Business Name): LILIA ANDRSIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 S CENTRAL AVE
GLENDALE CA
91204-2504
US

IV. Provider business mailing address

10505 FERNGLEN AVE
TUJUNGA CA
91042-1522
US

V. Phone/Fax

Practice location:
  • Phone: 818-736-1151
  • Fax:
Mailing address:
  • Phone: 818-736-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95030464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: