Provider Demographics
NPI:1376829747
Name:AGAZARYAN, DINA (FNP)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:
Last Name:AGAZARYAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18302 SIERRA HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-6124
Mailing Address - Country:US
Mailing Address - Phone:661-424-9159
Mailing Address - Fax:
Practice Address - Street 1:18302 SIERRA HWY STE 101
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-6124
Practice Address - Country:US
Practice Address - Phone:661-424-9159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily