Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 767212 | CA |
NPI | 1003353723 |
---|---|
Provider Name | Luiza Kristina Gevshanyan |
First Address | Van Nuys, CA 91405 |
Second Address | Van Nuys, CA 91405-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2017 |
Last Update Date | 26/01/2017 |