Healthcare Provider Details

I. General information

NPI: 1326869355
Provider Name (Legal Business Name): NARINE POGHOSYAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10633 CROCKETT STREET
SUN VALLEY CA
91352
US

IV. Provider business mailing address

10633 CROCKETT STREET
SUN VALLEY CA
91352-4027
US

V. Phone/Fax

Practice location:
  • Phone: 818-698-5487
  • Fax:
Mailing address:
  • Phone: 818-698-5487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10240738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: