Healthcare Provider Details

I. General information

NPI: 1861094039
Provider Name (Legal Business Name): ZARUI TER-POGOSYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14624 SHERMAN WAY STE 401
VAN NUYS CA
91405-5848
US

IV. Provider business mailing address

14624 SHERMAN WAY STE 401
VAN NUYS CA
91405-5848
US

V. Phone/Fax

Practice location:
  • Phone: 818-257-4035
  • Fax: 747-217-4325
Mailing address:
  • Phone: 818-281-5659
  • Fax: 747-217-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95015820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: