Provider Demographics
NPI:1285346833
Name:VARDANYAN, VARDUY ROSIE (RN)
Entity type:Individual
Prefix:
First Name:VARDUY
Middle Name:ROSIE
Last Name:VARDANYAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16509 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1856
Mailing Address - Country:US
Mailing Address - Phone:818-625-9373
Mailing Address - Fax:
Practice Address - Street 1:7515 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1949
Practice Address - Country:US
Practice Address - Phone:818-627-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA754124163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care