MEDICARE: LEVON TER-BAGDASARIAN ANP-C

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	363LA2200X	Adult Health Nurse Practitioner	13727	CA

General Provider Information

NPI Number	:	1891793089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEVON TER-BAGDASARIAN ANP-C

Provider Business Mailing Address
First Line	:	1560 E CHEVY CHASE DR STE 130
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4140
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 E CHEVY CHASE DR STE 130
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4140
Country	:	US
Telephone Number	:	818-240-0340
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/16/2024

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