Provider Demographics
NPI:1841698479
Name:BAGRAMYAN, ANGELO ANDRE (RN, BSN, PHN)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:ANDRE
Last Name:BAGRAMYAN
Suffix:
Gender:M
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16647 NEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1733
Mailing Address - Country:US
Mailing Address - Phone:818-624-1527
Mailing Address - Fax:
Practice Address - Street 1:16647 NEARVIEW DR
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-1733
Practice Address - Country:US
Practice Address - Phone:818-624-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-13
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA780512163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse