MEDICARE: DIANA GEVORGYAN NP

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	95034743	CA

General Provider Information

NPI Number	:	1427845783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA GEVORGYAN NP

Provider Business Mailing Address
First Line	:	1911 W GLENOAKS BLVD STE B
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-4746
Country	:	US
Telephone Number	:	818-843-6640
Fax Number	:	818-843-0347

Provider Business Practice Location Address
First Line	:	1911 W GLENOAKS BLVD STE B
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-4746
Country	:	US
Telephone Number	:	818-843-6640
Fax Number	:	818-843-0347

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

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/23/2025

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