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General NPI Number Information
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NPI Number | 1902455215
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Entity Type | Individual
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Provider Name | LIANA MARINA GEVORKIAN
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Gender | Female
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 12626 RIVERSIDE DR STE 301
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-3473
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Country | US
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Telephone | 818-452-9266
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Fax |
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Provider Business Mailing Address
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Address Line | 9310 HILLROSE ST
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City | SHADOW HILLS
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State | CA
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Zip | 91040-1768
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 95012550
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License Number State | CA
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