Provider Demographics
NPI:1093582546
Name:GRIGORYAN, SIRANUSH
Entity Type:Individual
Prefix:
First Name:SIRANUSH
Middle Name:
Last Name:GRIGORYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12812 OXNARD ST
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4315
Mailing Address - Country:US
Mailing Address - Phone:747-888-2584
Mailing Address - Fax:
Practice Address - Street 1:2701 W ALAMEDA AVE STE 302
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4408
Practice Address - Country:US
Practice Address - Phone:747-247-1130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95310358163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse