Healthcare Provider Details

I. General information

NPI: 1619813060
Provider Name (Legal Business Name): TINA ABOVYAN TINA ABOVYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14545 FRIAR ST STE 302
VAN NUYS CA
91411-2397
US

IV. Provider business mailing address

4325 LAUDERDALE AVE
LA CRESCENTA CA
91214-2461
US

V. Phone/Fax

Practice location:
  • Phone: 818-807-3663
  • Fax:
Mailing address:
  • Phone: 818-807-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: