Provider Demographics
NPI:1235640970
Name:KHATCHATOURIAN, ROBERT (DNP, NP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:KHATCHATOURIAN
Suffix:
Gender:M
Credentials:DNP, NP
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:KHATCHATOURIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, NP
Mailing Address - Street 1:2101 HILLHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2003
Mailing Address - Country:US
Mailing Address - Phone:323-664-2931
Mailing Address - Fax:323-664-8931
Practice Address - Street 1:2101 HILLHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-664-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008473363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF10170746OtherTHE AMERICAN ACADEMY OF NURSE PRACTITIONERS (AANP) BOARD CERTIFICATION