Healthcare Provider Details

I. General information

NPI: 1568887172
Provider Name (Legal Business Name): EVELYN GREGORIAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 N FAIR OAKS AVE
PASADENA CA
91103-1620
US

IV. Provider business mailing address

3641 1ST AVE
LA CRESCENTA CA
91214-2429
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-6342
  • Fax: 626-744-6148
Mailing address:
  • Phone: 818-653-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number757525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: