Healthcare Provider Details

I. General information

NPI: 1003433236
Provider Name (Legal Business Name): GAYANE CELINE BABAKHANIAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10560 PLAINVIEW AVE
TUJUNGA CA
91042-1718
US

IV. Provider business mailing address

10560 PLAINVIEW AVE
TUJUNGA CA
91042-1718
US

V. Phone/Fax

Practice location:
  • Phone: 818-579-3989
  • Fax:
Mailing address:
  • Phone: 818-579-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95014777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: