Healthcare Provider Details

I. General information

NPI: 1902455215
Provider Name (Legal Business Name): LIANA MARINA GEVORKIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12626 RIVERSIDE DR STE 301
VALLEY VILLAGE CA
91607-3473
US

IV. Provider business mailing address

9310 HILLROSE ST
SHADOW HILLS CA
91040-1768
US

V. Phone/Fax

Practice location:
  • Phone: 818-452-9266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95012550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: