Healthcare Provider Details

I. General information

NPI: 1720837362
Provider Name (Legal Business Name): IRINA AYRAPETYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 EAGLE ROCK BLVD STE 205
LOS ANGELES CA
90041-2087
US

IV. Provider business mailing address

6419 KRAFT AVE
NORTH HOLLYWOOD CA
91606-2624
US

V. Phone/Fax

Practice location:
  • Phone: 747-300-7541
  • Fax: 818-471-4287
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95024820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: