Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95012369 | CA |
NPI | 1003445768 |
---|---|
Provider Name | Anna Manukyan |
First Address | Glendale, CA 91208-2139 |
Second Address | Glendale, CA 91205-4552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2020 |
Last Update Date | 14/02/2022 |