MEDICARE: SELA KHACHIKYAN

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	95028822	CA

General Provider Information

NPI Number	:	1942065339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELA KHACHIKYAN

Provider Business Mailing Address
First Line	:	PO BOX 4412
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91222-0412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3217 N VERDUGO RD STE 1
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1676
Country	:	US
Telephone Number	:	818-369-7470
Fax Number	:

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

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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Directions to “ SELA KHACHIKYAN ” Practice Location

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