Provider Demographics
NPI:1205382231
Name:GRIGORYAN, GRIGOR (FNP-C)
Entity Type:Individual
Prefix:
First Name:GRIGOR
Middle Name:
Last Name:GRIGORYAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7335 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2968
Mailing Address - Country:US
Mailing Address - Phone:559-449-1209
Mailing Address - Fax:
Practice Address - Street 1:7335 N 1ST ST
Practice Address - Street 2:109
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2968
Practice Address - Country:US
Practice Address - Phone:559-449-1209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily