Healthcare Provider Details

I. General information

NPI: 1922942390
Provider Name (Legal Business Name): ANUSH VARDUMYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 CANBY AVE STE 6B
RESEDA CA
91335-2975
US

IV. Provider business mailing address

2433 MONTROSE AVE
MONTROSE CA
91020-1419
US

V. Phone/Fax

Practice location:
  • Phone: 818-674-4414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95037583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: