Provider Demographics
NPI:1124719083
Name:SHAHINYAN, KRISTINE SATENIK
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:SATENIK
Last Name:SHAHINYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 ALLOTT AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5525
Mailing Address - Country:US
Mailing Address - Phone:323-422-8696
Mailing Address - Fax:
Practice Address - Street 1:8012 ALLOTT AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5525
Practice Address - Country:US
Practice Address - Phone:323-422-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022788363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner