MEDICARE: TINA GEVORGYAN

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	95036225	CA

General Provider Information

NPI Number	:	1821950080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA GEVORGYAN

Provider Business Mailing Address
First Line	:	122 W LOMITA AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 W LOMITA AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1713
Country	:	US
Telephone Number	:	818-424-0054
Fax Number	:

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

Provider Enumeration Date	:	11/26/2025
Last Update Date	:	02/17/2026

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Directions to “ TINA GEVORGYAN ” Practice Location

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