Healthcare Provider Details

I. General information

NPI: 1588256416
Provider Name (Legal Business Name): NAIRA GYULARYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6882 GULFPORT BLVD S
SOUTH PASADENA FL
33707-2108
US

IV. Provider business mailing address

2585 COUNTRYSIDE BLVD APT 212
CLEARWATER FL
33761-3531
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-9655
  • Fax:
Mailing address:
  • Phone: 727-420-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH16676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: