Provider Demographics
NPI:1033691944
Name:GHAZARIAN, KRISTINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:GHAZARIAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 ARDEN AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4026
Mailing Address - Country:US
Mailing Address - Phone:818-242-3916
Mailing Address - Fax:
Practice Address - Street 1:435 ARDEN AVE STE 550
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4026
Practice Address - Country:US
Practice Address - Phone:818-242-3916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily