Healthcare Provider Details

I. General information

NPI: 1730726357
Provider Name (Legal Business Name): TATEVIK VICKY KUIUMJIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9561 TEXHOMA AVE
NORTHRIDGE CA
91325-2046
US

IV. Provider business mailing address

9561 TEXHOMA AVE
NORTHRIDGE CA
91325-2046
US

V. Phone/Fax

Practice location:
  • Phone: 818-456-8126
  • Fax:
Mailing address:
  • Phone: 818-456-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number847187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: