Provider Demographics
NPI:1104584481
Name:AGHAZARYAN, SEVAK
Entity type:Individual
Prefix:
First Name:SEVAK
Middle Name:
Last Name:AGHAZARYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8026 WENTWORTH ST
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2139
Mailing Address - Country:US
Mailing Address - Phone:818-726-8010
Mailing Address - Fax:
Practice Address - Street 1:8026 WENTWORTH ST
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2139
Practice Address - Country:US
Practice Address - Phone:818-726-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018713363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care