Healthcare Provider Details

I. General information

NPI: 1629754510
Provider Name (Legal Business Name): ZORIK DERYAGHOOBIAN FNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 E COLORADO BLVD # 1230
PASADENA CA
91107-3870
US

IV. Provider business mailing address

3660 E COLORADO BLVD # 1230
PASADENA CA
91107-3870
US

V. Phone/Fax

Practice location:
  • Phone: 888-971-1977
  • Fax:
Mailing address:
  • Phone: 626-553-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95017698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: