Provider Demographics
NPI:1275316473
Name:GYULNAZARYAN, MARIAM MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:MICHELLE
Last Name:GYULNAZARYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6906 VARNA AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4358
Mailing Address - Country:US
Mailing Address - Phone:818-807-7377
Mailing Address - Fax:
Practice Address - Street 1:6906 VARNA AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4358
Practice Address - Country:US
Practice Address - Phone:818-807-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant