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General NPI Number Information
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NPI Number | 1073239851
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Entity Type | Individual
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Provider Name | VIKTORYA VICKI GEZALIAN FNP
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Gender | Female
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 1332 S GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91205-3349
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Country | US
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Telephone | 818-243-4344
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Fax | 818-243-4510
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Provider Business Mailing Address
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Address Line | 1332 S GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91205-3349
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Country | US
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Telephone | 818-243-4344
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Fax | 818-243-4510
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95022559
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License Number State | CA
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