MEDICARE: MARIAM GRIGORYAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95188437	CA

General Provider Information

NPI Number	:	1144179789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM GRIGORYAN

Provider Business Mailing Address
First Line	:	1149 LINDEN AVE APT 1
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1575
Country	:	US
Telephone Number	:	818-667-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1149 LINDEN AVE APT 1
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1575
Country	:	US
Telephone Number	:	818-667-6262
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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