=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235831652
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANA KIRAKOSYAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2023
-----------------------------------------------------
Last Update Date | 05/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1234 N VERMONT AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90029-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-660-5624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9900 CABANAS AVE
-----------------------------------------------------
City | TUJUNGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91042-2929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-319-6483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 742425
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 742425
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------