Provider Demographics
NPI:1912740556
Name:SOGHOMONYAN, VEHANUSH (NP)
Entity type:Individual
Prefix:
First Name:VEHANUSH
Middle Name:
Last Name:SOGHOMONYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2972 HAWKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1346
Mailing Address - Country:US
Mailing Address - Phone:323-388-9944
Mailing Address - Fax:
Practice Address - Street 1:2972 HAWKRIDGE DR
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1346
Practice Address - Country:US
Practice Address - Phone:323-388-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025813363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care