Healthcare Provider Details

I. General information

NPI: 1528994225
Provider Name (Legal Business Name): ANI ANGEL GABRIELYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 MIRA VISTA AVE
MONTROSE CA
91020-1506
US

IV. Provider business mailing address

2246 MIRA VISTA AVE
MONTROSE CA
91020-1506
US

V. Phone/Fax

Practice location:
  • Phone: 818-486-8175
  • Fax:
Mailing address:
  • Phone: 818-486-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN95336480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: