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General NPI Number Information
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NPI Number | 1770473910
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Entity Type | Individual
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Provider Name | HARUTYUN VAHAN AYVAZYAN
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Gender | Male
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 601 N KENWOOD ST UNIT 106
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City | GLENDALE
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State | CA
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Zip | 91206-2372
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Country | US
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Telephone | 818-804-9525
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Fax |
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Provider Business Mailing Address
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Address Line | 601 N KENWOOD ST UNIT 106
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City | GLENDALE
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State | CA
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Zip | 91206-2372
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Country | US
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Telephone |
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | PMH06250135
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License Number State | CA
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