Healthcare Provider Details

I. General information

NPI: 1174076483
Provider Name (Legal Business Name): MARIA KEKLIKIAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18251 ROSCOE BLVD
NORTHRIDGE CA
91325-4200
US

IV. Provider business mailing address

11501 SEMINOLE CIR
PORTER RANCH CA
91326-1419
US

V. Phone/Fax

Practice location:
  • Phone: 818-605-1090
  • Fax:
Mailing address:
  • Phone: 818-605-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: