Healthcare Provider Details

I. General information

NPI: 1538095872
Provider Name (Legal Business Name): JULLIETTE KESTENIAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12139 RIVERSIDE DR
VALLEY VILLAGE CA
91607-3832
US

IV. Provider business mailing address

1031 W KENNETH RD
GLENDALE CA
91202-1440
US

V. Phone/Fax

Practice location:
  • Phone: 818-763-3937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: