Healthcare Provider Details

I. General information

NPI: 1801600994
Provider Name (Legal Business Name): TINA BEDROSSIAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 GLENWOOD AVE
LA CRESCENTA CA
91214-3904
US

IV. Provider business mailing address

310 N JACKSON ST APT 301
GLENDALE CA
91206-3608
US

V. Phone/Fax

Practice location:
  • Phone: 818-232-8008
  • Fax:
Mailing address:
  • Phone: 818-653-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95109215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: