Provider Demographics
NPI:1427845783
Name:GEVORGYAN, DIANA (NP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GEVORGYAN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 W GLENOAKS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-4746
Mailing Address - Country:US
Mailing Address - Phone:818-843-6640
Mailing Address - Fax:818-843-0347
Practice Address - Street 1:1911 W GLENOAKS BLVD STE B
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-4746
Practice Address - Country:US
Practice Address - Phone:818-843-6640
Practice Address - Fax:818-843-0347
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily