MEDICARE: MS. DINA AGAZARYAN FNP

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	630977	CA

General Provider Information

NPI Number	:	1376829747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DINA AGAZARYAN FNP

Provider Business Mailing Address
First Line	:	8363 RESEDA BLVD # 209
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-4623
Country	:	US
Telephone Number	:	818-335-4443
Fax Number	:	818-457-5633

Provider Business Practice Location Address
First Line	:	8363 RESEDA BLVD # 209
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-4623
Country	:	US
Telephone Number	:	818-335-4443
Fax Number	:

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

Provider Enumeration Date	:	10/28/2011
Last Update Date	:	03/19/2026

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