Healthcare Provider Details

I. General information

NPI: 1356284814
Provider Name (Legal Business Name): MASHA GRIGORIEVNA MARKOSYAN MSN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11840 W TUDOR CT
PORTER RANCH CA
91326-4985
US

IV. Provider business mailing address

11840 W TUDOR CT
PORTER RANCH CA
91326-4985
US

V. Phone/Fax

Practice location:
  • Phone: 818-641-8786
  • Fax:
Mailing address:
  • Phone: 818-641-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: