Healthcare Provider Details

I. General information

NPI: 1760353049
Provider Name (Legal Business Name): LUSINE LUCY DUSHIKYAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S SIERRA MADRE BLVD
PASADENA CA
91107-5240
US

IV. Provider business mailing address

14137 LEADWELL ST
VAN NUYS CA
91405-2440
US

V. Phone/Fax

Practice location:
  • Phone: 818-361-5437
  • Fax:
Mailing address:
  • Phone: 818-299-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95032726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: