Healthcare Provider Details

I. General information

NPI: 1083482160
Provider Name (Legal Business Name): TATIANA GENJOYAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 FOOTHILL BLVD
LA CANADA CA
91011-3221
US

IV. Provider business mailing address

80 AVENUE P APT D13
BROOKLYN NY
11204-6114
US

V. Phone/Fax

Practice location:
  • Phone: 818-361-5437
  • Fax:
Mailing address:
  • Phone: 929-289-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: