Provider Demographics
NPI:1326789595
Name:MKHITARYAN, LILIA (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:
Last Name:MKHITARYAN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17116 BARNESTON ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2441
Mailing Address - Country:US
Mailing Address - Phone:310-779-2955
Mailing Address - Fax:
Practice Address - Street 1:17116 BARNESTON ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-2441
Practice Address - Country:US
Practice Address - Phone:310-779-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95019946OtherBRN NP
CAF09210358OtherAANP